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Heroin Addiction and Related Clinical Problems: 2021, 23, N1 (pages: 65 - 70)

Switching All Patients from Racemic to Levomethadone as a Challenge to Public Health

Deruvo G., Elia C., Mercadante M., Mongiello F., Guareschi M., and Maremmani I.

Summary: The ‘real life' switch from racemic methadone to levomethadone in all patients receiving treatment at the Addiction Unit in Bitonto-Palo del Colle (province of Bari) proved to be a feasible option, both effective and well tolerated. Methadone and levomethadone can be safely switched in either direction to replace each other, applying a dose ratio between the two of approximately 2:1. In our experience, in fact, most of the patients needed progressive increases in their daily dose of levomethadone, in some cases using stepwise increases of over 30%. The need for constant updating in addiction medicine and for the implementation of this knowledge in clinical practice are further challenges in the field of public health. Public policies should aim to achieve clearly defined basic objectives that seek to change the social situation with the objective of solving a problem or improving a situation. These objectives may be arranged in the order of their importance, for example by distinguishing primary from secondary aims, or staggering separate interventions over time. In our opinion, the needs addressed by public policy are not only guaranteeing public health by avoiding the marginalization of dependent people and reducing the social burden arising from the problem of dependence. It is up to policy makers to go further by providing resources to improve the state of health of Substance Use Disorder patients. On this view, enacting any drug improvement promptly, in clinical practice and for all patients, is surely not a secondary or optional task of public health.