Methadone Maintenance Therapy Research Articles

Opioid use and COVID-19: a secondary analysis of the impact of relaxation of methadone take-home dosing guidelines on use of illicit opioids

ABSTRACT Background: An exemption to existing U.S. regulation of methadone maintenance therapy after the onset of the COVID−19 pandemic permitted increased take-home doses beginning March 2020. Objectives: We assessed the impact of this exemption on opioid use. Methods: A pre/post study of 187 clients recruited from an OTP who completed a survey and consented to share their urine drug testing (UDT) data. Use of fentanyl, morphine, hydromorphone, codeine, and heroin was assessed via UDT. Receipt of take-home methadone doses was assessed from clinic records for 142 working days pre- and post-COVID exemption. Analysis was conducted using a linear regression model to assess the association between increased take-home doses and use of illicit opioids. Results: In the pre- vs. post-COVID−19 SAMHSA exemption periods, 26.2% vs. 36.3% of UDTs were positive for 6-acetylmorphine respectively, 32.6% vs. 40.6% positive for codeine, 34.2% vs 44.2% positive for hydromorphone, 39.5% vs. 48.1% positive for morphine, 8.0% vs. 14.4% positive for fentanyl (p-value < .001). However, in the unadjusted descriptive data, when grouped by change in substance use, those clients who experienced a decrease in the use of morphine, codeine, and heroin post-COVID−19 were given significantly more take-home doses than the groups that had no change or an increase in the use of these substances. In the adjusted model, there was no significant relationship between change in opioid use and increased receipt of take-home methadone doses. Conclusions: Although take-home doses post-COVID−19 nearly doubled, this increase was not associated with a significant change in use of illicit opioids.

The four-factor personality model and its qualitative correlates among opioid agonist therapy clients.

The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice. Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis. Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected. Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.

Changes to methadone maintenance therapy in the United States, Canada, and Australia during the COVID-19 pandemic: A narrative review

IntroductionIn response to the COVID-19 pandemic, countries across the world made adaptations to policies regulating the provision of methadone maintenance therapy (MMT) to facilitate social distancing for health care providers and people in treatment. Many countries issued guidance about increasing take-home methadone doses after the onset of the pandemic. MethodsIn this review, we compare the regulation of MMT prior to the pandemic in the United States, Canada, and Australia, analyze changes to treatment policy in the context of COVID-19, and review emerging data on treatment outcomes. ResultsThe United States only permits the prescription and disbursement of methadone for MMT treatment at federally designated opioid treatment programs (OTPs). Conversely, Australia and Canada operate on a community pharmacy-based distribution model, where patients can access methadone doses either in participating pharmacies or in some methadone clinics. ConclusionGiven reports of similar treatment outcomes and increased patient satisfaction since the pandemic-related policy changes, some changes including increased receipt of take-home doses should be considered for incorporation into post-pandemic treatment policies and regulations.

Predictors of Linkage to an Opioid Treatment Program and Methadone Treatment Retention following Hospital Discharge in a Safety-Net Setting

Background: Methadone is increasingly initiated during hospitalization for the treatment of opioid use disorder (OUD). However, little is known about which factors are associated with linkage to opioid treatment programs (OTP) and retention in methadone maintenance therapy (MMT) following hospital discharge. Materials & Methods: This is a retrospective study of adults with OUD hospitalized in an urban, safety-net hospital referred by inpatient clinicians to an onsite OTP for post-discharge MMT follow-up from October 2017 to July 2019. We used multivariable modified Poisson regression models to generate adjusted risk ratios (aRR) for associations of sociodemographic factors, mental health disorders, alcohol use, stimulant use, and prior care engagement with post-discharge OTP enrollment and MMT retention at 30 and 90-days. Results: Of the 125 patients referred, 40% enrolled in the OTP post-discharge. Among enrollees, 74% were retained at 30-days and 52% were retained at 90-days. Patients with co-occurring stimulant use were less likely to enroll in the OTP post-discharge compared to those without stimulant use (aRR 0.65, 95% CI 0.44–0.97). We found no associations with 30-day MMT retention, but patients who reported stable housing were more likely to be retained in MMT at 90-days compared to those without stable housing (aRR 1.66, 95% CI 1.03–2.66). Conclusion: Our findings suggest that hospitalized patients with co-occurring stimulant use may need additional support to optimize post-discharge OTP linkage. Stable housing may improve retention in MMT. Additional research is needed to identify trends in MMT engagement among those referred from the acute hospital setting.

Taiwan study cautions against methadone for drivers; NIDA responds

A recent literature review from Taiwan, “Risk of motor vehicle collisions after methadone use: A systematic review and meta‐analysis” by T.Y. Tsai and colleagues, found that methadone use is associated with an almost doubled risk of motor vehicle collisions, and concluded that “clinicians should exercise caution in implementing methadone maintenance therapy for drivers.” The study, published in the current issue of Drug and Alcohol Dependence, flies in the face of what is known in this country about methadone maintenance: that it is safe for driving when taken in therapeutic doses. We asked the National Institute on Drug Abuse (NIDA) to comment on the study. Here is what they said.

NIDA comments on Taiwan methadone‐driving study

A recent literature review from Taiwan, “Risk of motor vehicle collisions after methadone use: A systematic review and meta‐analysis” by T.Y. Tsai and colleagues, found that methadone use is associated with an almost doubled risk of motor vehicle collisions, and concluded that “clinicians should exercise caution in implementing methadone maintenance therapy for drivers.” The study, published in the current issue of Drug and Alcohol Dependence, flies in the face of what is known in this country about methadone maintenance: That it is safe for driving when taken in therapeutic doses. ADAW asked the National Institute on Drug Abuse (NIDA) to comment on the study. Here is what they said.

Economic, social, and clinic influences on opioid treatment program retention in Dar es Salaam, Tanzania: a qualitative study

BackgroundMedications for opioid use disorder (MOUD) are associated with positive health outcomes. People remaining on MOUD have a reduced likelihood of drug overdose and mortality. Tanzania supports a national opioid treatment program (OTP) offering MOUD, but retention is a continual challenge. To date, most research on MOUD retention in Tanzania and other Sub-Saharan Africa settings has been focused on the individual-level, with little attention to economic, social, and clinic-level factors.MethodsWe qualitatively examined economic, social, and clinic factors that affect retention on MOUD, specifically methadone maintenance therapy, among former and current clients attending an OTP clinic Dar es Salaam, Tanzania. We conducted in-depth interviews with a total of 40 current and former clients receiving MOUD and four focus groups with an additional 35 current clients on MOUD between January and April 2020. We utilized a thematic analysis approach.ResultsDaily OTP clinic attendance posed a financial burden to current and former clients and was a barrier to remaining on MOUD. Though treatment is free, clients described struggles to attend clinic, including being able to afford transportation. Female clients were differentially impacted, as sex work was the most common income-generating activity that they participated in, which presented its own set of unique challenges, including barriers to attending during set clinic hours. Drug use stigma acted as a barrier to MOUD and prevented clients from securing a job, rebuilding trust within the community, and accessing transportation to attend the clinic. Being able to rebuild trust with family facilitated remaining on MOUD, as family provided social and financial support. Caretaking responsibilities and familial expectations among female clients conflicted with MOUD adherence. Finally, clinic level factors, such as clinic dispensing hours and punitive consequences for breaking rules, posed barriers to clients on MOUD.ConclusionSocial and structural factors, both within (e.g., clinic policies) and outside of (e.g., transportation) the clinic impact MOUD retention. Our findings can inform interventions and policies to address economic and social barriers to MOUD, that can contribute to sustained recovery.

Methadone Maintenance Therapy after Aneurysmal Subarachnoid Hemorrhage: A Case Report

There is limited information on the effects of continued methadone maintenance therapy following aneurysmal subarachnoid hemorrhage (aSAH). However, with the increasing incidence of opioid use disorder (OUD) in the US, there is a need to define best practices for the management of pain and prevention of acute withdrawal syndrome in patients with pre-existing OUD who develop aSAH. In this case report, we describe the use of MMT in a patient with aSAH and discuss important considerations, including sedation or confusion that might mimic acute neurologic changes seen in cerebral vasospasm or delayed cerebral ischemia, cardiac complications related to QTc prolongation, and liver or kidney interactions associated with aSAH routine treatment. Our patient recovered from her aSAH without any adverse events and, with increased monitoring and collaborative team-based care, including input from those with expertise in OMD or aSAH, we believe MMT can be safely continued in most aSAH patients.

Risk of motor vehicle collisions after methadone use: A systematic review and meta-analysis

IntroductionMethadone maintenance therapy is a leading treatment strategy for stabilizing and rehabilitating patients with opioid dependence; however, findings related to the risk of motor vehicle collisions after methadone use have been conflicting. In the present study, we compiled the available evidence on the risk of motor vehicle collisions after methadone use. MethodsWe completed a systematic review and meta-analysis of studies identified on six databases. Two reviewers independently screened the identified epidemiological studies, extracted data, and used the Newcastle–Ottawa Scale to assess the quality of the studies. Risk ratios were retrieved for analysis, conducted using random-effects model. Sensitivity analyses, subgroup analyses, and tests for publication bias were conducted. ResultsAmong 1446 identified relevant studies, a total of 7 epidemiological studies enrolling 33226142 participants met the inclusion criteria. Overall, study participants with methadone use had a higher risk of motor vehicle collisions than did those without methadone use (pooled relative risk 1.92, 95% CI 1.25–2.95; number needed to harm 11.3, 95% CI 5.3–41.6); the I2 statistic was 95.1%, indicating substantial heterogeneity. Subgroup analyses revealed that database type explained 95.36% of the between-study variance (p = 0.008). Egger’s (p = 0.376) and Begg’s (p = 0.293) tests revealed no evidence of publication bias. Sensitivity analyses indicated that the pooled results were robust. ConclusionThe present review revealed that methadone use is significantly associated with a nearly doubled risk of motor vehicle collisions. Therefore, clinicians should exercise caution in implementing methadone maintenance therapy for drivers.

Royal Jelly bioactive compounds and exercise improved cardiomyopathy and redox status in patients under methadone maintenance therapy: Randomized clinical trial

BackgroundDrug abuse is one of the world's most significant health policy concerns. Long-time opium use is significantly associated with the incidence of coronary artery disease and altered liver enzyme concentration and function. MethodsIn this randomized clinical trial, 80 men addicted to opium and who underwent methadone maintenance therapy (MMT) were randomized to four groups, including the control group, cases that performed resistance band exercise, cases that consumed Royal Jelly, cases that performed resistant band exercise and consumed Royal Jelly (100 mg/kg). Serum levels of antioxidative, cardiac, and liver function were measured at the baseline and end of the study (eight weeks). The vital proteins were screened by in silico analysis. Moreover, the authors found 18 microRNAs with a significant differential expression in the addiction status as dynamic monitoring biomarkers. ResultsThe concentration of the catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and total antioxidant capacity (TAC) were significantly increased in men who performed exercise and consumed Royal Jelly (RJ+EX) compared with the other groups. Moreover, we found that cardiac and liver function concentrations such as troponin-1, malondialdehyde, creatine kinase, lactate dehydrogenase, alanine transaminase, aspartate aminotransferase, and alkaline phosphatase were improved in the RJ+EX group. ConclusionArtificial intelligence and experimental tests concluded that consuming Royal Jelly and regular exercise training programs might be the adjunct protocol to MMT, improving quality of life and side effects of methadone therapy.

Effectiveness of Emotion Regulation Training Based on Gross Model in Impulsivity and Sensation Seeking in Men with Substance Abuse on Methadone Maintenance Therapy in the West of Iran (Ilam Province)

Background: The low level of emotional regulation, caused by the inability to deal with emotions and manage them, plays a role in substance abuse. Objectives: This study aimed to determine the effectiveness of emotion regulation training, based on the Gross model, in impulsivity and sensation seeking in substance abusers on methadone maintenance therapy in Ilam province. Materials and Methods: The current quasi-experimental study used a pretest-posttest design. The population of this research included all substance users in the rehabilitation centers (clinics) throughout Ilam province receiving methadone maintenance therapy. Sixty individuals were selected by random sampling and assigned randomly into two groups (n = 30) of control and experiment (n = 30). The experimental group received an eight-week intervention (a 90-minute session per week), and the control group did not receive any intervention or training. At the end of the course, a posttest was administered for both groups. Data were collected through two questionnaires of Barret and ZSSSC (Zuckerman's sensation-seeking scale) and analyzed using MANCOVA. Results: Covariance analysis showed that training addicts on methadone maintenance therapy to regulate their emotions reduced impulsivity and excitement compared to the control group (P &lt; 0.0001). Conclusions: As male substance abusers are more exposed to negative emotions, they act impulsively and without a plan in this situation. Therefore, training them to regulate their emotions can increase their control in such cases.

ADVERSE PHYSICAL EFFECTS OF ANTIRETROVIRAL THERAPY AND METHADONE ON PEOPLE LIVING WITH HIV/AIDS (PLWHA) USING INJECTION DRUGS (IDUS)

Background: People with HIV who use injecting drugs besides taking ARVs also use methadone. With these conditions, of course there will be a risk of causing various side effects. Based on this, researchers are interested in exploring the physical side effects experienced by PLWHA IDUs while using ARV therapy and Methadone. Method: This qualitative research uses a phenomenological study approach. Participants were taken based on criteria referring to the purposive sampling technique (snowball sampling). Participants were PLWHA with a history of injecting drug users (IDU) aged 20 years and over and had undergone ARV therapy and Methadone maintenance therapy for at least 6 months. Researchers conducted semi-structured in-depth interviews and used Colaizzi's data analysis stages. Results: HIV AIDS sufferers who inject drug users experience physical side effects on the digestive system, namely tooth decay, constipation, anorexia. Side effects on the musculoskeletal system include muscle pain and weakness and insomnia. Side effects of the covering system are the appearance of itching and rashes. Side effect on the reproductive system is a decrease in sexual function. Recommendation: The results of this study need to be followed up with studies with a larger number of participants so that they can represent other problems experienced by PLWHA while using ARV therapy and methadone together.

The Effect of 3 Years of Methadone Maintenance Therapy on Biochemical and Biophysical Parameters of Opioid Use Disorder Patients

The Effect of 3 Years of Methadone Maintenance Therapy on Biochemical and Biophysical Parameters of Opioid Use Disorder Patients

Treatment Satisfaction Questionnaire for Medication (TSQM Version II): A Psychometric Properties Analysis

Background: Methadone or buprenorphine maintenance therapy is an effective treatment for opioid dependence. Since the satisfaction of patients under methadone maintenance treatment (MMT) plays an important role in their therapeutic success, it seems important to evaluate the satisfaction of methadone usage using multidimensional psychometric tools. Objectives: The current study aimed to investigate the psychometric properties of the Persian version of the Treatment Satisfaction Questionnaire for Medication (TSQM) version II. Patients and Methods: This cross‑sectional study was carried out on 288 opioid-dependent patients of Shahid Beheshti MMT clinic in Kerman, Iran, selected using the convenience sampling method. The data were collected using a questionnaire containing the demographic characteristics of the participants and the Persian version of the TSQM version II containing 11 items in four subscales of effectiveness, side effects, convenience of use, and overall satisfaction. The sum of the scores of each subscale is displayed as a number from 0 to 100. The face and content validity of the questionnaire was confirmed. The construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency and repeatability of the TSQM version II were determined using Cronbach’s alpha and test-retest methods, respectively. LISREL software (version 8.8) and SPSS software (version 20.0) were used to analyze the data. Results: The sample with the male majority of 85% had a mean age of 46.24 ± 11.5 years. As a measure of internal consistency, Cronbach’s alpha of the Persian version of the TSQM version II was 0.8. The repeatability of the questionnaire using the test-retest method was calculated at 0.9. The EFA revealed the adequacy of sampling and justifiability of the analysis (Kaiser‑Meyer‑Olkin = 0.82, P = 0.001, χ2 = 1507.02, df = 28). In CFA, the goodness of fit was at an appropriate level. Conclusions: The TSQM Persian version can be used as an effective and consistent tool to assess treatment satisfaction in clinical settings.

An intervention pilot to facilitate harm reduction service decentralization in Vietnam

IntroductionHarm reduction services, including methadone maintenance therapy (MMT), have been decentralized to Vietnam's community health care settings. This study aims to pilot test an intervention to facilitate decentralized harm reduction service delivery in Vietnam. MethodsThe research team conducted an intervention pilot between August 2020 and May 2021 with six community MMT distribution sites in Thai Nguyen Province of Vietnam. We recruited five commune health workers (CHW) from each center (N = 30). In-person intervention training included content to correct misconceptions about harm reduction and reduce stigmatizing attitudes toward patients who use drugs and teach CHWs to self-examine and improve their service provision process. The study team developed a web-based platform to streamline CHW's patient monitoring and referral efforts. The team assessed intervention outcomes at baseline, 3-, and 6-months. CHWs in the intervention group provided acceptability ratings and feedback on the intervention at 6-months. ResultsCHWs in both intervention and control groups had similar background characteristics and outcome measures at baseline. CHWs in the intervention group, compared to those in the control group, showed a significantly higher level of improvement in adherence to service delivery protocol at 3-months. CHW in the intervention group had a significantly lower level of management-related stress compared to the control group at 6-months, although the intervention effect measured by the difference in change from baseline was not statistically significant. CHWs who participated in the final focus group reported high acceptability of the intervention. ConclusionThis intervention pilot demonstrated acceptability and promising outcomes on community-based harm reduction service delivery. Similar intervention strategies can be applied to enhance the decentralization of other chronic disease treatment services.

Chronic exposure to methadone induces activated microglia and astrocyte and cell death in the cerebellum of adult male rats.

Methadone is a centrally-acting synthetic opioid analgesic widely used in the methadone maintenance therapy (MMT) programs throughout the world. Considering its neurotoxic effects particularly on the cerebellum, this study aims to address the behavioral and histological alterations in the cerebellar cortex associated with methadone administration. Twenty-four adult male albino rats were randomized into two groups of control and methadone treatment. Methadone was subcutaneously administered (2.5-10mg/kg) once a day for two consecutive weeks. The functional and structural changes in the cerebellum were compared to the control group. Our data revealed that treating rats with methadone not only induced cerebellar atrophy, but also prompted the actuation of microgliosis, astrogliosis, and apoptotic biomarkers. We further demonstrated that treating rats with methadone increased complexity of astrocyte processes and decreased complexity of microglia processes. Our result showed that methadone impaired motor coordination and locomotor performance and neuromuscular activity. Additionally, relative gene expression of TNF-α, caspase-3 and RIPK3 increased significantly due to methadone. Our findings suggest that methadone administration has a neurodegenerative effect on the cerebellar cortex via dysregulation of microgliosis, astrogliosis, apoptosis, and neuro-inflammation.

Investigation on consumption of psychoactive substances and their ecological risks using wastewater-based epidemiology: a case study on Qinghai-Tibet Plateau.

The Qinghai-Tibet Plateau is the third pole of the world, and information on the consumption of psychoactive substances (PSs) in this area is scarce. In this study, we selected Qinghai Province as the research area, and the per capita consumption and prevalence of PSs were investigated using wastewater-based epidemiology. Samples from 17 wastewater treatment plants (WWTPs) in 5 major cities in Qinghai Province were monitored, and 11 PSs were detected by ultra-high performance liquid chromatography-tandem mass spectrometry. Results showed that the target compounds were detected in all samples, with relatively high concentrations of ephedrine (2.1-4825.3ng/L) and methamphetamine (1.5-295.7ng/L). The consumption of methamphetamine in Xining City, Haidong City, and Haixi City was up to 78.4, 16.8, and 21.2mg/1000 inh/d (the PS consumption per 1000 inhabitants in 1day), respectively, higher than that in the other two cities, which was the result of the different consumption patterns and its relationship with the economic levels of each city. High consumption of methadone (47.9mg/1000 inh/day) was found in Xining City, which might be related to the methadone maintenance therapy sites in the city. Methamphetamine was the most prevalent drug, with the prevalence ranging from 0.003 (Guoluo) to 0.197% (Xining), and the prevalence of other PSs was low. The ecological risk assessment of PSs in the effluent of WWTPs showed that methadone exerted a low risk to aquatic organisms in three sites, while other substances posed potential risk or no risk. However, the long-term effect of PSs cannot be ignored.

HCV treatment in Sardinian HIV-HCV coinfected patients: a real-life perspective study on safety, efficacy, and immune reconstitution

ABSTRACT Background HIV-HCV co-infected patients have long been considered difficult-to-treat. The introduction of direct-acting antivirals (DAAs) changed this paradigm.We evaluated the efficacy and safety of DAA-based regimens and the impact of DAAs-induced HCV clearance on the immunological status in HIV-HCV co-infected patients. Research design and methods HIV patients starting HCV treatment with DAAs were included. Sustained virological response at 12 weeks after DAAs treatment (SVR12) was assessed. CD4+ and CD8+ blood cell count and CD4+/CD8+ ratio were recorded at baseline and six months post DAA treatment. We enrolled 201 patients, 76.1% males, median age 54 years, the most common genotypes 3 (29.8%) and 1a (29.4%), 40.3% with cirrhosis, 32.3% with prior interferon-based treatment. All patients were on antiretroviral treatment, 24.4% on methadone maintenance therapy and 22.6% on psychotropic drugs. Results SVR12 was 98.4%, the most common side effects were pruritus (8.4%), headache (7.4%) and fatigue (5.9%). An increase in CD4+ and CD8+ cell count was observed six months after completion of DAAs treatment, in particular in patients with low CD4+ cell count at baseline. Conclusions DAAs treatment resulted in high SVR12 rates, was well tolerated and Increased CD4+ and CD8+, especially in patients with low CD4+ cell count at baseline.

Access to needles and syringes and methadone maintenance therapy among people who inject drugs in Yangon, Myanmar: a qualitative study

BackgroundAccess to sterile needles, syringes and methadone maintenance therapy (MMT) is critical to reduce the prevalence of bloodborne virus infections among people who inject drugs (PWID). We aimed to explore the experiences of PWID with respect to accessing needles/syringes services and MMT in Yangon, Myanmar.MethodsBurnet Institute implemented a community-based hepatitis C testing and treatment (CT2) program for PWID with on-site needles and syringes distribution. Separate from CT2, MMT was available at two government-run sites in Yangon. We conducted in-depth interviews with 15 PWID who received hepatitis C care in this program. Interviews were transcribed verbatim and translated into English. Thematic data analysis was performed using NVivo12 software.ResultsSelf-reported changes to needles/syringes sharing behaviour after hepatitis C education in the CT2 program and commencement of treatment were observed. One third of participants reported they became aware of the risks of sharing and reusing needles/syringes, and consequently refrained from sharing after the CT2 program. Inadequate availability of NSPs, cost of needles/syringes, and issues maintaining privacy when accessing needles/syringes emerged as key barriers to accessibility of needles/syringes. Participants described difficulties in accessing free needles/syringes. They were not aware of other free needles/syringes services at the time of the interview. Purchasing needles/syringes from pharmacies had privacy and confidentiality concerns. Structural barriers to accessibility of MMT were identified for both MMT sites in Yangon. Of the two MMT sites in Yangon, participants reported that the Ywarthargyi center had strict eligibility criteria for take-home methadone and transportation issues as it was located in the outskirt of the town. The Thingyangyun center was in a more convenient location, but only offered daily observed doses and had a long waiting time which was burdensome for some employed participants.ConclusionExpansion of free needles/syringes services and adaptations of MMT to consider the needs and individual preferences of PWID will improve their access to these services and would likely reduce injecting related harms.

SSRI potentiation of methadone cardiotoxicity

Methadone maintenance therapy, commonly used in the treatment of opioid use disorder, has been associated with electrocardiographic QT interval prolongation.1 With comorbid mental illness often seen in methadone‐treated patients,2 concurrent antidepressant use is likely. This results in a high potential for drug interaction, especially with selective serotonin reuptake inhibitors (SSRIs).