l-Acetylmethadol (LAM) treatment of opiate dependence: plasma and urine levels of two pharmacologically active metabolites

The metabolic conversion of α-$\text{l}$-acetylmethadol (LAM) to α-$\text{l}$-noracetylmethadol (NAM) and α-$\text{l}$-dinoracetylmethanol (NNAM), has been studied in three opiate addicts being maintained on 100 mg of LAM three times weekly. Plasma levels of NAM and NNAM were established shortly after the initial dose of LAM. The plasma level of NNAM was substantially higher following repeated dosing than following the initial dose. The combined daily urinary excretion of LAM, NAM and NNAM was 6–8 times greater after repeated dosing than after the initial dose. Since NAM and NNAM, which are formed by the sequential N-demethylation of LAM are both considerably more active morphine-like agonists than is LAM itself, it is likely that the pharmacological effects of LAM are due to NAe NAM and NNAM. Variations in the rates of formation and elimination of NAM and NNAM may partially explain the variability in response seen in LAM maintenance therapy.