INDUCTION WITH LEVOMETHADYL ACETATE - SAFETY AND EFFICACY

Background: 'Levomeihadyl acetate hydrochloride (known as LAAM) is a m u-opioid agonist approved for the treatment of opioid dependence. Clin ical trials comparing LAAM and methadone have reported lower patient r etention rates during LAAM induction; however: this may reflect dose a nd schedule differences. Few studies have systematically examined LAAM dose induction. This study compared induction with 3 different LAAM d osage levels. Methods: In a randomized, double-blind trial, male and f emale opioid-dependent patients (N = 180) were assigned to 1 of 3 LAAM doses. The low-dose (25 mg) induction was constant from the onset of treatment, the medium-dose (50 mg) induction lasted 7 days, and the hi gh-dose (100 mg) induction lasted 17 days. Safety and efficacy were as sessed on retention, urinalysis and self-reported drug use, symptoms,a nd patient ratings of medication adequacy. Results: The high-dose grou p had significantly fewer illicit opioid-positive urine samples in wee ks 3 and 4 as compared with the low-dose group. Tl-le high-dose group had significantly lower self-reported heroin craving in weeks 2 and 3. All groups demonstrated significant decreases in illicit drug use, wi thdrawal symptoms, and depression. There were no between-group differe nces in retention; however, there was a trend (P =.08) for lower reten tion and a greater number of agonist adverse effects were observed in the high-dose group. Overall, LAAM doses were well tolerated by most p atients. Conclusion: Induction with low and medium LAAM doses can be s afely and effectively achieved within 7 days. Induction with higher LA AM doses can be safely achieved within 17 days, but may result in grea ter rates of patient dropout and opioid agonist adverse effects. There fore, higher doses should be approached more slowly.