The head-to-head study published in The Lancet last month (see ADAW, Nov. 20) showing that Vivitrol and buprenorphine are equally beneficial in retaining patients at 6 months elicited some questions from reader Sam Snodgrass, Ph.D. First, the buprenorphine dosing was too low, suggested Snodgrass. The “median maintenance dose of 16 mg/day (12–18)” was given, but “the most effective doses range from 16 mg to 32 mg,” said Snodgrass. The dose of Vivitrol used was the maximum, he said. “They are comparing a minimally effective dose of buprenorphine to a maximally effective dose of naltrexone,” he said. Perhaps buprenorphine would have performed better than Vivitrol if the doses had been higher?