This TIP, titled LAAM in the Treatment of Opiate Addiction, presents current knowledge about the use of levo-alpha-acetyl-methadol (LAAM), an opioid agonist medication approved for use in 1993. LAAM suppresses opiate withdrawal symptoms for more than 72 hours, and it can be administered no more frequently than every other day. Thus, daily visits to the program clinic are not required for LAAM-maintained patients, as are visits for patients on methadone. In addition to the difference in dosing schedule, no take-home doses of LAAM are permitted under Federal regulations, and women of child-bearing potential must be tested monthly for pregnancy.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Chapter 1 - Introduction
  • Development of LAAM
  • Use of LAAM in Opioid Substitution Therapy Programs
  • Purpose of This TIP
  • Concerns of the Consensus Panel
  • Overview of This TIP
• Chapter 2 - Clinical Profile of LAAM
  • Metabolism and Mechanism of Action
  • Drug Interactions
  • Effects of LAAM Treatment in Specific Clinical Situations and Patient Populations
  • Issues for Further Research
• Chapter 3 - Clinical Application of LAAM Therapy
  • Selection of Patients
  • Induction Onto LAAM
  • Maintenance on LAAM
  • Withdrawal and Termination From LAAM Therapy
• Chapter 4 - Treatment Planning
  • Patient Education
  • Counseling and Case Management
  • Discharge Planning
  • Patient Monitoring: Routine Testing
• Chapter 5 - Management and Administrative Issues
  • Setting
  • Staffing Considerations
  • Medication Dispensing
  • Costs
  • Quality of Care
  • Monitoring Program Quality
  • Consideration of Public Policy Issues
  • Concerns Regarding Use of LAAM
• Chapter 6 - Regulatory and Ethical Issues
  • Approval of Treatment Programs to Dispense LAAM
  • Use of LAAM: Effects on Other Systems
  • Ethical Issues in the Administration of LAAM
• Appendix A - Bibliography
• Appendix B - Training Resources
• Appendix C - Federal Resource Panel
• Appendix D - Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, MS, served as the CSAT Government project officer. Robert A Lubran, MS, MPA, was the Government content advisor. Carolyn Davis, Constance Gartner, Linda Harteker, Lise Markl, Barbara Shapiro, and Deborah Shuman served as writers.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U. S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.