Re: Letter from J. Trujols, N. Siñol & J. Pérez De Los Cobos

Dear Sir,

We thank Trujols et al. for their interest in our paper and their insightful comments.

They comment on the low dose of methadone prescribed in our patients (33.6–56 ml/day at booking and 28.2–57.9 ml/day at delivery) compared to doses recommended in Department of Health guidelines (60–120 ml/day). It should be noted that the pregnant women in the study are all offered a dose reducing slow detoxification programme and therefore the dose at the end of pregnancy is often a reduced dose compared with the initial stabilising dose. Similarly, many women taking prescribed methadone when booking in pregnancy were already enrolled in a similar programme and had been using larger amounts of methadone in the past.

The lack of correlation between the dose of prescribed methadone and the indices of neonatal withdrawal makes it difficult to counsel pregnant women, however the adverse effect of heroin use is evident in our practice (Fajemirokun-Odudeyi et al. 2006; Sinha et al. 2001).

Whether changing methadone-prescribing guidelines are responsible for the increased doses used or whether the severity of addiction has increased, is difficult to differentiate with certainty, hence our title ‘evidence of progression in the severity of addiction’ and not proof. It is notable that the trends in our study were common to all groups of women, namely the successful methadone substitution programme women, and the women who continued to use heroin.

We agree with Trujols et al. that evidence for our treatments is a priority.

Declaration of interest: The author report no conflicts of interest. The author alone is responsible for the content and writing of the paper.