Albrecht Ulmer, a physician with extensive experience in maintenance with codeine, points out that this treatment was developed by general practitioners and spread from physician to physician by word of mouth, rather than through publication in professional journals. Nobody is involved in this kind of substitution except the maintained patient and her personal physician, and the access to the treated population is quite difficult. Studies, therefore, are rare. The treatment regimen itself is very simple, and is based on a personal agreement between physician and patient. In most cases, each prescription is for enough medication for several days, or even weeks, i.e., take-home is very liberal.
Dosage varies considerably according to patient needs and duration of treatment.
Different preparations are available, including liquid, but volume is still a major problem because of the low concentration. Patients normally have to pay for their medication, since in general health insurance agencies and companies refuse to pay for the medication when used in maintenance treatment of addiction. First of all, there are those who do not tolerate methadone. And there is a third group of patients, who are treated with this substance because a more suitable treatment with methadone is denied them by arbitrary regulations or because of a lack of physicians willing to prescribe methadone. On the other hand, Degkwitz et al.