Methadone dosing, heroin affordability, and the severity of addiction

Objectives. This study sought to track changes in US heroin prices from 198 8 to 1995 and to determine whether changes in the affordability of heroin w ere associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. Methods. Data on the price of heroin were from the Drug Enforcement Adminis tration, data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that c ontrolled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher dos es of methadone, which would suggest that these patients had relatively hig her physiological levels of opiate addiction owing to increased heroin use. Results. The amount of pure heroin contained in a $100 (US) purchase has in creased on average 3-fold between 1988 and 1995. The average dose of methad one in clinics was positively associated with the affordability of local he roin (P < .01). Conclusions. When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction-evidence that they are consuming more heroin.