SAFER OPTION

Thank you for the excellent piece on methadone and Buprenorphine (WM,
City Desk / "A new drug to end drug abuse," May 27). You'll want to
clarify in the next issue that methadone is taken orally as well, not
injected as you say [see correction, this page]. Patients swallow
their methadone dose under the supervision of clinic staff. Observed
dosing is part of a strategy to prevent the diversion of the
medication outside of the program. After three to six months of doing
well on the treatment, you start to earn the right to "take home
doses" -- bottles of methadone that you can take home with you and
swallow there without having to travel to the clinic site.

I also wanted to mention that I remember well the editorial that you
cite at the end of your piece. It has been recognized for years that
the period immediately after completing a detox program is a higher
risk time for overdose. Patients lose their tolerance to opiates
during the detox process. That means when they return home, they are
much more sensitive to the effects of opiates, and if they take the
same amount that they did before detox, they are very likely to overdose.

A related phenomenon has been noticed with maintenance treatment,
especially for people just starting out. Methadone and Buprenorphine
have some blocking effect on other opiates such as heroin. Patients
who start the treatment and are still using drugs may find they don't
get high from their usual doses of drug. This may push them to take
more and more, in search of a high, which can lead to overdose.

The story cited in that editorial is tragic, but it is important to
remember that patients in maintenance treatment have a death rate of
one-third of what it is for heroin users not in treatment. Maintenance
treatment with methadone or Buprenorphine is by far the safer option.

Thanks again for you article and for contacting me to participate.

Jeff Baxter, MD

Family Health Center of Worcester