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Because prisoners with preincarceration heroin dependence typically relapse following release, a pilot study examined a novel opioid agonist maintenance program whereby consenting males initiated levo-alpha-acetylmethadol (LAAM) treatment shortly before release from prison with opportunity to continue maintenance in the community. Treated prisoners (experimental group) were compared with controls who received community treatment referral information only and prisoners who withdrew from treatment prior to medication regarding treatment participation and community adjustment during nine months post-release. Nineteen of 20 (95%) prisoners who initiated maintenance in prison entered community treatment, compared with 3 of 31 (10%) controls, and 1 of 13 (8%) who withdrew. Moreover, 53% of experimental participants remained in community treatment at least six months, while no other participants did so. Differences in heroin use and criminal involvement between experimental participants and each of the other two groups, while not consistently statistically significant, uniformly favored the experimental group. Despite study limitations, robust findings regarding treatment attendance suggest that this intervention is highly promising.

A patient undergoing management of heroin dependency with high dosages of the long-acting methadone derivative, levomethadyl acetate HCl (LAAM; ORLAAM) developed a prolonged QTc interval and polymorphic QRS complexes on EKG consistent with torsades de pointes (TdP). The patient was taking other drugs known to prolong the QTc interval (fluoxetine and IV cocaine), and those known to antagonize the activity of the P450 enzymes responsible for the metabolism of LAAM and its active metabolite (fluoxetine, cocaine and marijuana). No previous reports have appeared in the literature attributing this adverse event to LAAM therapy; however, five similar cases have been reported to the manufacturer. Animal studies indicate that LAAM and metabolites prolong the action potential duration of myocardial cells. We propose that predisposed patients on high doses of LAAM may be at risk for developing TdP. Patients being treated with LAAM should receive dosages consistent with guidelines and be evaluated for concomitant diseases, interacting drug therapies, and EKG abnormalities.

(1979). Women on LAAM Maintenance: Initial Experiences. Journal of Psychedelic Drugs: Vol. 11, No. 3, pp. 223-229.

(1975). 1-α -Acetylmethadol (LAAM) Pharmacokinetics and Metabolism: Current Status. The American Journal of Drug and Alcohol Abuse: Vol. 2, No. 3-4, pp. 301-305.

With the expansion of methadone maintenance there has been an increase in accidental ingestion and related deaths. This is at least partially due to programs involving take-home methadone. The use of 1-alpha-acetylmethadol (LAAM), a congener of methadone that suppresses withdrawal for up to 72 hours, may reduce diversion and accidental overdose.

(1975). On the Role off Chemotherapy in the Treatment of Heroin Addiction. The American Journal of Drug and Alcohol Abuse: Vol. 2, No. 3-4, pp. 279-288.