Treatment should be tailored for each patient

EDITOR,—Michael Farrell and colleagues note that for successful maintenance treatment of people dependent on opiates high doses of methadone are needed, and they recommend a dose of 70-120 mg a day.1 High doses are essential for people with chronic dependence, particularly long term injecting misusers, who may use more than one drug, but it is doubtful whether extended treatment with high doses is suitable for people who smoke heroin and who meet the criteria for substitute prescribing. When heroin is smoked or inhaled (rather than injected) the equivalent …