Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China.

Qian Lu,Xia Zou,Li Ling,Cheng Gong,Yin Liu

doi:10.3390/ijerph16152800

Abstract

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%–89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%–89% of the tapering phase increased the odds of heroin abstinence.

Highlights

IntroductionMethadone Maintenance Treatment (MMT) has proved to be one of the most effective methods for dealing with opioid addiction worldwide, and has served millions of participants since the 1950s [2,3,4]
Opioid dependence continues to be a serious public health problem
Our retrospective study provides strong supplementary evidence for their inclusion into current guidelines, we advise participants who want to taper to start the tapering phase after 52 weeks, with a more gradual taper ratio of less than 5%/week and a dose reduction in 75%–89% of the tapering weeks, as this provided the highest odds of heroin abstinence

Summary

Introduction

Methadone Maintenance Treatment (MMT) has proved to be one of the most effective methods for dealing with opioid addiction worldwide, and has served millions of participants since the 1950s [2,3,4]. There has, been debate and controversy as to whether methadone should be provided indefinitely or whether participants should taper off after a period of stabilization [5]. Most countries have described a framework for MMT dose adjustment that includes a starting dose, titration phase, maintenance phase, and the participant can choose to enter a tapering phase or to continue with the maintenance phase [6,7,8,9]. Studies have shown that 41%–57% of participants undergo the tapering phase [6,7,8], the reasons for this are said to be due to the severe side effects, pressure from family members, expectations around full recovery and fear concerning methadone’s harm and/or dependency [9,10,11]

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