Will non-compliant 'hard-to-treat' opioid-dependent patients profit from low threshold methadone treatment? A prospective 15-month evaluation of patients on Low Dosage Methadone treatment at Oslo University Hospital

Introduction: In 2014, Oslo University Hospital introduced a Safe Low Dose Methadone (SLDM) project in an effort to reach 'hard-to-treat' opioid-dependent patients that were unable to comply with previous treatment plans. The basic assumption was that a dosage of 60 mg methadone adminstered daily should provide adequate physical abstinence relief with only a low risk of respiratory depression, even when combined with central depressants. Methods: This prospective study is a follow-up of 20 'hard-to-treat' patients in SLDM over a period of 15 months. All patients were benefiting from a 'stable living situation' prior to titration. Treatment status was evaluated at 2, 7 and 15 months after the cut-off period for inclusion. Results: Eighty per cent of the patients were on methadone at the 15 months evaluation follow-up. There were no serious intoxications or overdoses reported among any of the 20 patients during the study period. Conclusions: 'Hard-to-treat' patients may be treated successfully and responsibly with low dose methadone when this takes place within a tightly controlled framework.