Effect of Methadone Dose on Cocaine Abuse in a Methadone Program

The effect of methadone dose on cocaine abuse in methadone‐maintained patients was examined in two protocols at separate treatment sites in the Yale Department of Psychiatry. In one protocol, methadone dose was lowered in response to each cocaine‐positive urine and raised to a maximum of 70 mg in response to abstinence (negative urine toxicology screen for 2 weeks). Of 22 patients treated under this protocol, 33% stopped cocaine use for a minimum of 2 weeks. In a second protocol, methadone dose was raised in response to each cocaine‐positive urine to a maximum dose of 120 mg qd. Ten patients have entered this protocol to date, and 8 responded to this treatment by stopping cocaine abuse for a minimum of 2 weeks. Thus, the increasing methadone dose contingency treatment was more effective (80% vs. 33%, P = 0.02, Fisher's Exact Test).