Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

184encouraged to return to methadone maintenance treatment for another prolongedperiod of time. Experience has shown that patients who stop meihadonemamteuance have a high relapse rate, especially it ihey have been on the methadonemaintenance program less than a year. Therefore, every effort shuula bemade on the part of program staff to retain patients in continuing treatment fora period of weeks or months after the patient begins a detoxification program.Patients in methadone maintenance should be treated with regular doses ofmethadone between SO and 120 milligrams a day. Dose levels less than SO minigramsare discouraged because of the likelihood of continued drug abuse. Dosesabove 120 milligrams are to be discouraged because it is unlikely that they willproduce additional benefits to the patient. Under no circumstances are patientsto be given more than 150 milligrams of methadone a day.Methadone detoxification should in no circumstances be prolonged for morethan 3 months. A patient on detoxification should not receive more than 50 milligramsa day unless he is being detoxified from methadone maintenance. Thephysician in charge of the patient's treatment should establish a schedule forgradually decreasing doses with abstinence to be achieved between 2 weeks and3 months after the start of methadone detoxification. Urine results must bemonitored carefully in this group because of a strong likelihood that they willexperience renewed drug hunger and return to illegal drug use, particularly atdose levels below 40 milligrams a day. Evidence of renewed illegal drug use ordrug craving beyond the individual patient's ability to control it are indicationsfor the patient's going on methadone maintenance. Under no circumstancesshould a person be classified as methadone detoxification for more than 3 months.Methadone hold patients are classified in this group if they are given doses ofmethadone on an emergency basis prior to appropriate examination, diagnosisand disposition. Under no circumstances should a patient be retained in themethadone hold category for more than 2 weeks.Authorized medical representatives. Only physicians can sign prescriptions.Others, including nurses, medical assistants etc., may dispense methadone andsign NTA Form 6 (attachment 5).3. POLICYBecause people who are addicted to heroin often have many psychological andvocational problems requiring vigorous and effective treatment, IsTA's goal foreach patient is social rehabilitation. Methadone treatment must be consideredwithin this context as only one part of the total treatment program.The heroin addict patient may suffer from a number of medically treatableillnesses and for each of these, of course, the appropriate medical treatment isindicated. For example the heroin addict may have clinical schizophrenia withthe common symptoms of that illness. In this case, the most appropriate medicaltreatment includes a phenothiazine.Nevertheless, the only drug that has been shown to be useful in the treatmentof heroin addiction itself is methadone. Therefore, no other drug should beprescribed for treatment of heroin addiction. For example, there is no evidencethat tranquilizers or hypnotics are useful in the treatment of heroin addictionor heroin withdrawal. Furthermore, these drugs are specifically contraindicatedin the treatment of heroin addicts since they are likely to become drugs ofabuse in their own right. This is particularly true of the hypnotics (such asSeconal and doriden) but it is also true of the antianxiety tranquilizers (suchas librium and meprobamate). The heroin addict has, in part, gotten himselfin serious trouble because of his tendency to medicate himself and to treathis unpleasant feelings with a variety of drugs, especially heroin. Therefore,the physician dealing with heroin addicts can anticipate requests from the addictfor medications of all kinds. The doctor should be armed with the knowledgethat no tranquilizer or hypnotic has been shown to be useful in the treatmentof heroin addiction. He should share this information with the patient. However,the physician should avoid routine use of either type of drug. The physicianshould never prescribe these drugs for more than a few days because of thelikelihood of producing dependence on, or even addiction to, these drugs.Meth