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Methadone maintenance treatment (MMT) has a long history of effectiveness and safety as a therapy for opioid addiction. However, since it is a highly potent drug, methadone’s improper prescription and/or its misuse can be harmful or even fatal. The most adequate methadone dose provides an
effective response in the patient, with a margin for safety, for an appropriate duration of time. However, there is wide variation in patient response, due in part to the complexities of how methadone works and individual patient differences.
Methadone dosing should be determined on an individual basis, without artificial dose limits,
while exercising caution to avoid adverse effects. The key to initiating methadone dosing is to start low and go slow. However, research evidence confirms that maintenance doses ultimately greater than commonly considered in some MMT programs may be necessary for many patients. Clinical signs and patient-reported symptoms of either overmedication or withdrawal, along with drug craving and/or continuing illicit-opioid use, are vital indicators for achieving dose adequacy.
Finally, patient education is an essential component of safety in MMT. This should be combined with efforts to foster open, trusting relationships between patients and clinic staff, which will produce the most successful treatment outcomes.
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