A number of issues are relevant to the development and use of
levo-alpha-acetylmethadol (
LAAM) as a treatment alternative to
methadone. A brief history of
methadone maintenance treatment is provided and variants of standard
methadone treatment are discussed. The history and current status of
LAAm are discussed, as well as its advantages over
methadone. In addition, relevant clinical, research, and policy issues are addressed.
LAAm has advantages over
methadone specifically with regard to thrice-weekly dosing, potential to reduce HIV/
AIDS risk, possible cost savings, and possible improved clinic-community relations. The effective and cost-effective implementation of
LAAM as a new treatment for
opioid addiction requires attention to a number of issues: (1)
LAAM as an HIV prevention measure through its potential risk-reduction effects, (2) the sue of
LAAM with specific high-risk subgroups, (3) causes of differential rates of treatment dropout and their amenability to intervention, (4) the role fo patient choice in long-term maintenance treatment, (5) the impact of
LAAM on clinic operations, (6) the potential for
LAAM as a take-home medication, and (7) the costs of implementing and sustaining
LAAM maintenance services.