Implementation of a clinic policy of client-regulated methadone dosing

A six-month interval (baseline) during which methadone doses above 99 mg re quired individual approval by the clinic's physician was compared with the subsequent 16-month period in which a policy of patient-regulated methadone dosing with no preset upper limit was implemented. During the later phase, all patients were required to remain at each selected dose for a minimum o f four days, and standard compliance-based take-home dosing procedures were followed. For patients in the study sample (n = 57), the daily maximum met hadone dose increased from 165 mg during baseline to 300 mg during the self -regulation period, while their average daily methadone dose increased from 76.84 mg to 80.04 mg (W = 473, n = 57, p = 0.01). Monthly percent of opiat e-positive urine specimens decreased significantly from 5.26% during baseli ne to 1.64% during the self-regulated dose period (W = 169, n = 57, p < 0.0 1), and use of other drugs remained unchanged. No patient failed to show po ssession of recalled take-home doses, and no instances of liquid methadone diversion were reported by law enforcement agencies in the area. (C) 2001 E lsevier Science Inc. All rights reserved.