Question - Why is abstinence not necessary prior to the initiation of methadone therapy for opiate abuse disorder?
Answer- The cited article points out: “In contrast with naltrexone, methadone (a full opioid agonist) is not associated with a risk of precipitated withdrawal, so abstinence before the initiation of methadone treatment is not necessary. However, because methadone has a relatively long and unpredictable half-life, the treatment must be initiated carefully. An initial low dose and slow approach helps to ensure that the patient is not over-sedated during the first several weeks.” (Walley AY et al. Case 6-2019: A 29-year-old woman with nausea, vomiting and diarrhea. 2019 NEJM 380(8): 772-779)
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