Pubdate: Sat, 10 Apr 1999 Source: Lancet, The (UK) (Volume 353, Number 9160) Contact: http://www.thelancet.com/ Author: Xavier Bosch SPAIN'S OPIATE ADDICTS TO BE GIVEN ANOTHER CHOICE The Spanish Ministry of Health approved dispensation of levo-alpha-acetyl-methadol (LAAM) to opioid addicts as a therapeutic alternative to methadone on March 30. This decision comes after encouraging results from a 3-month pilot study by the National Commission of Agonists (NCA) in 224 opioid addicts from 13 autonomous communities. NCA president, Guillermo Guigou said "LAAM offers some clear advantages over methadone", namely: "higher comfort levels since patients have to go to the dispensing centres only two or three times a week and not on a daily basis; fewer physical withdrawal symptoms; fewer desires for consuming opioids; and a lack of significant side effects." "LAAM treatment shows an 80% efficacy thus, it is fairly feasible that methadone-treated patients switch to LAAM", added Guigou. The disadvantages of LAAM include contraindication during pregnancy and in patients with severe liver abnormalities, such as liver cirrhosis or chronic viral hepatitis. LAAM is also very expensive: it is estimated that 500 mL of LAAM costs US$330-500, about US$2 per dose. During the XVI Jornadas Nacionales Socidrogalcohol, a national symposium on drugs, alcohol, and society (Canary Islands, Spain; March 29-30) Walter Ling, from the University of California (Los Angeles, USA) emphasised the importance of LAAM. As a therapeutic alternative, LAAM gives patients a greater chance of social integration and offers an improved quality of life to the addicts and their families, he said. Ling explained that once given, each LAAM dose is metabolised into two compounds, one of them having a potency six-fold greater than methadone. LAAM, a long-lasting opioid agonist which blocks the effects of other opiates and prevents withdrawal, has effects which last 48-72 hours. The longer efficacy means the addict can undergo a quicker rehabilitation by being able to spend more time on activities, such as occupational workshops and psychotherapy classes. The Ministry of Health is providing training courses from May to raise awareness of LAAM amongst 500 health-care professionals who care for drug addicts. Currently about 58,000 people are receiving opiate-replacement treatment with methadone in Spain. - --- MAP posted-by: Patrick Henry