Abstract
Methadone maintenance is a standard treatment for opiate-dependent individuals. However, deficits in cognitive functioning have been associated with this treatment. This study aimed to determine the dose and treatment duration-related effects of methadone on executive functions. Pure male opioid users with no considerable history of other drug abuse, undergoing methadone maintenance treatment (MMT) were recruited from a major government-run de-addiction center. Hot executive functions including decision-making and emotion recognition were assessed using the Iowa gambling task and Ekman faces test, whereas cold executive functions including working memory (WM), cognitive flexibility, and response inhibition were assessed using n-back, Wisconsin card sorting test, and the GO/NOGO task, respectively. Statistical Analyses Used: Descriptive statistics, Pearson's correlation coefficients, and multiple regression analysis were used to test the hypotheses of the study. Methadone dose and length of MMT were found to be associated with greater impairment in executive functions. Impairment in cognitive performance was also found to be inversely related to time since dosing. Regression analyses revealed that methadone dosage and time since dosing accounted for a significant proportion of the variance in cognitive flexibility, while the total amount of methadone administered was able to predict deficits in WM, methadone treatment duration predicted psychomotor speed, and time since dosing predicted decision-making ability. To keep cognitive impairment at a minimum, methadone dose and treatment duration will have to be customized considering the history of opiate abuse so that impairment attributable to long-term opiate use may be differentiated from acute methadone dosing.
Highlights
Opiate dependence is a serious health hazard worldwide, and in most countries, methadone substitution treatment is the standard evidence‐based treatment for opiate‐dependent individuals
The present study used a single sample design to investigate the association of methadone dose, duration of maintenance treatment (MMT), total amount of methadone consumed, and time elapsed since last dose with hot and cold executive functions in methadone maintenance patients
Analysis of the effects of methadone dose revealed that among the cold executive functions, deficits in cognitive flexibility correlated positively with methadone dose indicating that individuals who were receiving a higher dose of the drug revealed greater deficits
Summary
Opiate dependence is a serious health hazard worldwide, and in most countries, methadone substitution treatment is the standard evidence‐based treatment for opiate‐dependent individuals. Methadone maintenance treatment (MMT) is a comprehensive treatment program that involves the prescription of methadone as an alternative to the opioid on which the individual was dependent. Research has demonstrated that once the individual is stabilized at the right dose, long‐term methadone prescription alleviates withdrawal symptoms, blocks euphoric effects, and reduces craving associated with opioids.[1] Methadone has been reported to improve physical and mental health, social functioning, and quality of life.[2] In terms of benefits for society, MMT has the potential to reduce illicit drug use, criminal activity, and incidence of HIV infection.[3,4,5,6,7]. Recent evidence suggests that these functions can be classified into two broad domains: (i) Cold executive functions that demand greater use of rationality and logic, such as working memory (WM), cognitive flexibility, response inhibition, and planning and (ii) hot executive functions that involve emotion, such as decision‐making and emotion perception.[11]
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