LAAM 221
LAAM, and some prefer methadone. LAAM is related to methadone and is
generally considered weaker, but some research has found LAAM stronger in
certain ways. A dose of LAAM can last three times as long as one from meth-
adone, making LAAM more convenient for addicts in a treatment program,
as they can come less often to the clinic to receive LAAM than if they were
receiving methadone. Convenience can influence an addict’s decision on
whether to continue with a program. Another LAAM advantage is that the
long-lasting nature of a dose means that effects may be steadier over a given
amount of time than those from methadone, allowing more consistent job
performance by addicted employees. A case report mentions addicts who pre-
ferred LAAM over methadone because LAAM’s steadiness reduced mood
swings that occurred with methadone. One experiment, however, discovered
that LAAM users are far more physically active on days when they receive
the drug than on days when they don’t—a finding that questions whether
LAAM effects are as steady as commonly believed. Scientists know less about
actions of LAAM than about those of methadone, so sometimes addicts with
complicated medical conditions are given methadone instead of LAAM be-
cause methadone’s influence on those conditions is better understood.
Experimentation with rhesus monkeys revealed that LAAM does not nec-
essarily have uniform cross-tolerance with other opioids. Thus switching
someone to LAAM from another opioid can be tricky; LAAM may closely
match the other drug in some ways but not in others. For example, the same
level of pain relief may be achieved by particular doses of LAAM or some
other opioid, but those same doses will not necessarily affect breathing to the
same extent.
LAAM is supposed to provide no drug high to persons on maintenance
doses, but by definition a “maintenance” dose is only enough to hold off
withdrawal symptoms and not enough to produce effects desired by drug
misusers. So the lack of a high may be related to size of dose rather than to
chemistry of the drug.
Dependence can develop.
Drug interactions.Because of oral LAAM’s slow onset of effects, judging
safe amounts to take with other depressants can be perilous.Alcoholis con-
sidered especially risky to use with LAAM.Phenobarbitalis suspected of
altering the effectiveness of an LAAM dose, and the same suspicion holds for
the epilepsy drugs carbamazepine and phenytoin, the tuberculosis medicine
rifampin, and the antacid-ulcer drug cimetidine.
Cancer.LAAM’s potential for causing cancer is unknown. Data from labo-
ratory tests are inconclusive. One two-year test of the drug on rats and mice
produced no evidence of cancer, but another two-year test yielded some evi-
dence of liver cancer in rats. A human LAAM study looking for chromosome
mutations, which can lead to cancer, found none. Another human study found
no evidence of tumor development.
Pregnancy.LAAM’s impact on fetal development is unknown, but concern
is high enough that women of childbearing age are supposed to have monthly
pregnancy tests while on LAAM and to switch to methadone if pregnancy
occurs. Upon examining results from chicken and rat experiments, however,
some researchers suspect that more fetal damage may occur by stopping ex-