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Heroin Addiction and Related Clinical Problems: 2018, 20, N2 (pages: 41 - 50)

How to Improve a Poorly Running Agonist Opioid Treatment (Aot). Part 5: Higher Dosage

Ulmer A., and Meinhold C.

Summary: Long term mental problems, especially restlessness and inner stress, remain in a relevant number of AOT patients, often connected with the use of other addictive substances. This indicates, in nearly all cases, that the treatment is improvable. Opioids are pacifying substances. If patients show the mentioned symptoms, we can interpret it as a hint that the opioid dosage is inadequate. The dosage is not optimal, if more is experienced as better. We find many reports in references of better results with higher dosages. We have, therefore, prescribed increasingly higher dosages in the last years. The dosage exceeded 250 mg Methadone or equivalent 125 mg Levomethadone in 27 patients. That's 11.3% of the 239 patients, whose development we could document in charts. Average maximal dose was 359.7 mg (179.8 mg Levomethadone). A parallel alcohol problem was one of the main reasons in 16 of them. 10 of these could overcome this problem completely in connection with the high dose. We registered an extensive stabilization in the sense of a comprehensive normalization in 20 (74%) of the 27 patients. A clear increase of the dosage appears to be an effective instrument for the improvement of a poorly running AOT. It should be used much more often, also influencing the general setup, which will be discussed in detail.