Tcnj Journal of Student Scholarship Volume Xv April 2013 -1- Methadone Maintenance vs. Lamm Maintenance: Efficacy for Treating Opiate Addiction

AND INTRODUCTION One pharmacological treatment for opiate addiction is maintenance on opioid agonists (McKim, 2007). Maintenance drugs alleviate withdrawal symptoms, reduce craving, and block some of the effects of heroin, thereby decreasing the likelihood of relapse and drug-associated criminal behavior (McKim, 2007). Methadone is an orally-administered mu-opioid agonist, which was approved for maintenance therapy in the U.S. during the 1960s (Julien, Advokat, & Comaty, 2011). This drug has been rigorously tested and has been called the “most effective treatment for opiate addiction” by the Center for Disease Control (2002, p. 1). Despite this praise, methadone maintenance may not be the most preferred pharmacotherapy because of its short duration of action. Methadone is only effective for about 24 hours; consequently, patients are often required to return to the treatment facility each day to receive a new dose, which can be impractical, or are given take-home doses, which have abuse liability (McKim, 2007). Furthermore, methadone may not hold for a number of patients, such that they continue to experience withdrawal symptoms and craving despite receiving an adequate dose of the drug (Dyer & White, 1997). Levo-alpha acetylmethadol (LAAM) is an alternative agonist that may mitigate these issues because it has a longer duration of action than methadone and thus, is administered only three times per week (Julien et al., 2011). The purpose of this paper is to review the literature comparing the efficacy of methadone maintenance to LAAM maintenance for treating opiate addiction, and to assess LAAM’s viability as an alternative treatment. Several outcome variables are discussed, including retention in treatment, reduction in opiate use, involvement in criminal activity, effects on health, and patient preferences.