In a widely distributed letter to colleagues dated Sept. 12, 2003, J. Thomas Payte, MD, medical director of Colonial Management Group LP, discusses less than optimal methadone treatment outcome as a function of "bad patients" as opposed to "bad treatment." He concludes: "When faced with a 'difficult patient,' the first order of business is to ensure that the patient is receiving an adequate individualized dose [of methadone]." He goes on to stress that "adequacy of dose is based on two factors: How much? And how often" - i.e. divided dosages 2, 3 or more times per day. Dr. Payte has been in the forefront in stressing to colleagues the importance of considering multiple daily doses as well as increased total dosage in response to poor clinical response to treatment. He is based in Orlando, Florida, and his fax number is 407-3561-6930.

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