Role of maintenance treatment in opioid dependence

Methadone maintenance treatment (MMT) involves the daily administration of the oral opioid agonist methadone as a treatment for opioid dependence-a pe rsistent disorder with a substantial risk of premature death. MMT improves health and reduces illicit heroin use, infectious-disease transmission, and overdose death. However, its effectiveness is compromised if low maintenan ce doses of methadone (<60 mg) are used and patients are pressured to becom e prematurely abstinent from methadone. Pregnancy and psychiatric comorbidi ty are not contraindications for MMT. As an alternative to MMT, other oral opioid agents (eg, naltrexone, buprenorphine) may increase patient choice a nd avoid some of the more unpleasant aspects of MMT. The public-health chal lenge for the future is to develop and continue to deliver safe and effecti ve forms of opioid maintenance treatment to as many opioid-dependent indivi duals as can benefit from them.