USE OF LAAM IN TREATMENT (FROM HANDBOOK ON DRUG ABUSE, 1979, BY ROBERT DUPONT AND AVRAM GOLDSTEIN - SEE NCJ-57805)

• NCJ Number: 57812
• Author(s): W LING; J D BLAINE
• Date Published: 1979
• Length: 10 pages
• Corporate Author: US Dept of Health, Education, and Welfare
• Publication Format: Document
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

LEVO-ALPHAACETYLMETHADOL (LAAM) APPEARS TO BE EFFECTIVE IN TREATMENT OF ADDICTION TO OPIATES. THIS PAPER REVIEWS CLINICAL STUDIES ON ITS PHARMACOLOGICAL PROPERTIES AND DISCUSSES ISSUES IN ITS USE.

Abstract

ALTHOUGH INTEREST IN LAAM AS A LONG TERM TREATMENT AGENT FOR CHRONIC ADDICTION DID NOT EMERGE UNTIL THE LATE 1960'S, ITS SYNTHESIS AND EARLY INVESTIGATIONS OF ITS TOXIC AND ANALGESIC PROPERTIES WERE CARRIED OUT AS EARLY AS 1948. THESE STUDIES CONCLUDED THAT LAAM HAD A LONG DURATION OF ACTION AND EVEN GREATER EFFICACY WHEN ADMINISTERED ORALLY. THEY SUGGESTED THAT LAAM MIGHT BE USEFUL IN THE TREATMENT OF CHRONIC PAIN IF USED IN SMALL DOSES. CLINICAL INTEREST IN LAAM REEMERGED IN THE LATE 1960'S WITH THE GROWING POPULARITY OF METHADONE MAINTENANCE. THE FIRST CLINICAL TRIALS USING ACETYLMETHADOL IN NARCOTIC TREATMENT WERE CARRIED OUT IN THE LATE 1960'S AND EARLY 1970'S AND INVOLVED SAMPLES OF PATIENTS TREATED WITH BOTH D-L-ACETYLMETHADOL AND METHADONE. NO SIGNIFICANT DIFFERENCES BETWEEN THE TWO GROUPS AS REFLECTED BY DROPOUT RATES, EMPLOYMENT, ARRESTS, ILLICIT DRUG USE, CLINIC ATTENDANCE, AND DOSE CHANGES WERE REPORTED. SUBSEQUENT STUDIES AGAIN PROVIDED EVIDENCE OF THE SAFETY AND EFFICACY OF LAAM. BETWEEN 1973 AND 1976, TWO COOPERATIVE LAAM STUDIES WERE CARRIED OUT IN OVER 25 CLINICS (THE VA STUDY CARRIED OUT IN VETERANS ADMINISTRATION HOSPITALS AND THE SAODAP STUDY SPONSORED BY THE SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION.) IN BOTH, PATIENTS WERE EVALUATED AT BASELINE AND EVERY 4 WEEKS (BRIEF HISTORY AND PHYSICAL EXAMINATIONS, A CURRENT STATUS CHECK OF EMPLOYMENT, LEGAL INVOLVEMENT, INTERPERSONAL RELATIONSHIPS, ETC.) BOTH STUDIES SHOWED MORE THAN 40 PERCENT TREATMENT COMPLETION BY LAAM PATIENTS. NO SERIOUS ADVERSE REACTIONS WERE OBSERVED. A THIRD CLINICAL STUDY DONE IN 60 CLINICS AIMED AT OBTAINING 40-WEEK CLINICAL EXPERIENCES WITH 2,000 LAAM PATIENTS AND A METHADONE CONTROL GROUP. ALTHOUGH RESULTS ARE NOT YET AVAILABLE, EARLY INDICATIONS POINT TO AN IMPROVEMENT IN RETENTION RATES BY USING DIFFERENT CROSS-OVER SCHEDULES FROM DRUGS TO LAAM. CLINICAL IMPLICATIONS ARE DISCUSSED. REFERENCES ARE PROVIDED. FOR RELATED ARTICLES, PLEASE SEE NCJ 57805-57811 AND 57813-57834. (DAG)