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      Cost-Benefit Studies

      Cost-benefit studies repeatedly show that the benefits of methadone
      treatment outweigh the costs.   The large California CALDATA
      (Gerstein, Johnson, Harwood, Suter, & Malloy, 1994) study released
      in 1994 indicated that methadone treatment showed the greatest
      savings of all existing treatment and recovery modalities studied.  The
      study found a ratio of 1:10, meaning that $10 was saved for every $1
      invested in treatment.  Other  studies, usually focusing on single
      episodes of treatment, report similar findings.  A recent study that used
      a lifetime simulation model found a benefit-cost ratio of 1:38  (Zarkin,
      Dunlap, Hicks, & Mamo, 2005).  This model factors in existing data
      where possible to create a lifetime model more compatible with the
      view of addiction as a chronic disorder characterized by relapse over
      time, rather than an acute problem that can be addressed in a single
      treatment episode.

      Key Outside Reviews

      There are three outside scientific reviews that played a significant role
      in reducing the stigma and encouraging effective treatment.  In 1990,
      the Government Accounting Office (Government Accounting Office,
      1990) (since renamed Government Accountability Office) conducted a
      study of methadone programs and produced a striking finding about
      dosing.  Although the National Institute on Drug Abuse had
      documented that 60 mg methadone was a minimum adequate dose, 21
      of the 24 programs studied had average doses below that.  Often,
      physicians were constrained by “program policy” and could not
      prescribe appropriate doses.  Subsequent research documented that
      increasing the dose of methadone resulted in greatly improved
      retention and reductions in drug use.  Doses of 80 mg and above
      produced the best outcomes, with much higher doses required by some
      patients.  Unfortunately, it is still not unusual to find patients,
      clinicians and program administrators attempting to make a virtue out
      of low doses.  Patients vary enormously in their level of opiate
      tolerance and dependence, and in how well they absorb, metabolize
      and eliminate the medication.  Doses must be individualized and not
      limited by “policy.” If a patient is continuing to use opiates, the first
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