Methadone Maintenance Treatment Program Research Articles

Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico

The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.

Cognitive profiles in persons with opioid use disorder enrolled in methadone treatment

Cognitive impairment is common in persons with opioid use disorder and associated with poor treatment outcomes, including elevated risk for relapse. Much less is known about the underlying structure of these deficits and the possible presence of cognitive phenotypes. A total of 177 adults (average 42.2 years of age, 52.0% male, 65.5% Caucasian) enrolled in a methadone maintenance treatment program completed the NIH Toolbox as part of a larger project. Cluster analyses revealed a 2-cluster solution–persons with intact cognitive function in all domains (n = 93; Intact) and those with impairments on tests of attention and executive function (n = 83; Impaired). Follow-up analyses revealed that the Impaired group was slightly older, more likely to self-identify as a racial/ethnic minority, and less likely to report consuming alcohol four or more times per week. These findings suggest the existence of distinct cognitive profiles in persons with opioid use disorder and encourage further examination, particularly studies to examine the possible benefits of routine screening for cognitive impairment as part of substance use treatment.

One year of methadone maintenance treatment in a fentanyl endemic area: Safety, repeated exposure, retention, and remission

IntroductionFentanyl is a potent synthetic opioid that has contributed to increasing overdose deaths in the United States in recent years. Concern over safety and efficacy of agonist treatment for fentanyl use may limit access to treatment. This study sought to address these potential concerns in a naturalistic setting. ObjectivesMeasure 12-month treatment outcomes for methadone maintenance treatment (MMT) in a fentanyl endemic area. OutcomesPrimary: 1) Treatment retention; 2) sustained remission (defined as 3 consecutive negative screens); 3) return to use; 4) methadone dosage required; and 5) number of days to achieve remission.Secondary: Mortality. MethodsA naturalistic follow-up study and retrospective review of consecutive patients newly admitted to a single methadone maintenance treatment program in Rhode Island. ResultsWe observed 154 unique intake events (representing 151 patients). Eighty percent (n = 121) tested positive for fentanyl at intake. Seventy-five percent of patients achieved remission within the 12-month study period. One-year retention was 53% for fentanyl-exposed individuals and 47% for those not exposed. The majority (99%) of patients who remained in treatment at 12 months achieved remission. We saw prolonged, sustained remission in 44% of patients exposed to fentanyl at intake and 47% of those who were not. Dose and time to remission were similar. Unfortunately, 4 patients died after leaving MMT prematurely. ConclusionsThis study suggests MMT is safe despite repeated exposure to fentanyl while taking methadone. Remission is achievable, and MMT is protective against death among fentanyl-exposed patients while in treatment.

Methamphetamine use and misconceptions among primary and private Methadone Maintenance Treatment (MMT) program attendees in Klang Valley, Malaysia

ABSTRACT Background: Treatment-seeking opiate dependents in Methadone Maintenance Treatment (MMT) programs are predisposed to methamphetamine use. This study sought to determine the prevalence, reasons, and perceptions toward methamphetamine use among clients in primary and private MMT programs in Klang Valley (Malaysia). Method: 231 methadone users (n = 153 primary vs. n = 78 private clients) with current methamphetamine use history participated in this cross-sectional study. Results: Most participants were male (96%, n = 221/231), with the majority being Malay (84%, n = 194/231). More than two-thirds (71%, n = 164/231) initiated methamphetamine before MMT enrollment. Those who initiated methamphetamine after MMT enrollment had higher odds of reporting methamphetamine use in the last 7 days (OR: 2.28: 1.05–4.95; p <.033) and 30 days (OR: 2.49: 1.38–4.48; p <.002), than those who have initiated methamphetamine before joining MMT program. Compared to primary clients, private clients had higher odds of reporting opiate use in the last 30 days (OR: 1.86: 1.00–3.44; p <.048). Most participants used methamphetamine to increase work performance; the majority of participants believed that they can control methamphetamine use and that it was non-addictive, and safer when taken with methadone. Conclusion: Methamphetamine use appeared prevalent among MMT clients and the lack of information regarding the dangers of methamphetamine may be a probable cause.

Changes in quality of life and its associated factors among illicit drug users in Vietnamese mountainous provinces: a 12-month follow-up study

BackgroundSustainability of methadone maintenance treatment (MMT) program involves regularly assessing its impact on health and social outcomes of drug users in different settings, particularly in disadvantaged areas. In this study, we evaluated the change in quality of life (QoL), and identified associated factors amongst drug users over the course of 12-month MMT in Vietnamese mountainous provinces.MethodsWe conducted a longitudinal study among patients from 6 MMT clinics in three mountainous provinces of Vietnam. At baseline, we screened 300 participants and after a 12-month treatment, 244 participants remained to involve in the study. World Health Organization Quality of Life short form instrument (WHOQOL-BREF) was used to measure the QoL of patients. The magnitude of the changes was extrapolated.ResultsThere were significant changes in all four dimensions of quality of life measured by WHOQoL-BREF between baseline and 12 months with the effect size ranged from 0.21 to 0.24. Increased age, being workers compared to unemployment and having health problems or comorbidities were positively related to reduced scores of QoL.ConclusionsTo conclude, we observed a significant increase in the QoL level regarding physical, psychological, social relationships and environmental aspects among people who used drug after 12 months of MMT. Findings from this study emphasize the role of continuously receiving MMT treatment among people using drugs to enhance their QoL.

Translating Guān’ài in the People’s War on Drugs: Enacting Relations of Care in China’s State-Run Methadone Maintenance Treatment Program

China’s state-run methadone maintenance treatment (MMT) program was launched in 2003 in response to the growing HIV/AIDS epidemic and increasing criticism of compulsory rehabilitation centers. In conjunction with providing methadone replacement therapy, the Chinese state began promoting a politicized discourse of guān’ài 关爱 (care and love) as a more effective and humane method for dealing with drug users. While the medicalization of addiction as a chronic brain disease requiring long-term pharmaceutical treatment marked a watershed moment in the debate over drug control in China, the affective recasting of addiction as a social condition worthy of care is potentially even more revolutionary. But to what extent has this project transformed Chinese drug users into a legitimate target of (state) care? Based on ethnographic fieldwork conducted in Yunnan province from 2013 to 2019, we examine how various stakeholders in China’s MMT program (including methadone recipients, clinicians, public health officials, police officers, and the general public) have attempted to translate the discourse of guān’ài into workable practices and relationships based on divergent understandings of how to care for and about Chinese drug users. Our analysis shows how attending to the everyday dynamics of guān’ài in the People’s War on Drugs provides a novel approach to theorizing the fraught politics of care.

The reliability and validity of Reward Probability Index-Chinese version applied among individuals with opioid dependence

Objective To evaluate the reliability and validity of the Reward Probability Index-Chinese version (C-RPI) among individuals with opioid dependence. Methods A total of 160 individuals with opioid dependence were recruited from the methadone maintenance treatment(MMT) programs in Wuhan.The C-RPI was used in the investigation, and items/exploratory factors and confirmatory factors were adopted to analyze with IBM SPSS 22.0 and AMOS 24.0, respectively. Results The correlation between each item and the total score of the scale was 0.325-0.657 (all P<0.01) and the item discrimination of the scale was good.Exploratory factor analysis extracted two factors, including reward probability and environmental suppressors, and a load of each item on its factor ranged from 0.519 to 0.744.The fitting indexes of confirmatory factor analysis were as follows: χ2/df=1.623, RMR=0.030, RMSEA=0.063, IFI=0.902, TLI=0.885, CFI =0.900.The internal consistency coefficient (Cronbach's α) of the C-RPI was 0.800; and there was no ceiling/floor effect on each dimension and total scale. Conclusion The classification of dimensions for the C-RPI is reasonable, and the scale has good reliability and validity to measure the ability to obtain environmental rewards for individuals with opioid dependence. Key words: Reward probability index (RPI); Reliability; Validity; Opioid dependence

Turnover intention among service providers in Chinese methadone maintenance treatment clinics

High turnover rates among service providers have burdened addiction treatment clinics and affected patient care and treatment outcome. In this study, we identified factors associated with providers’ turnover intention in Chinese methadone maintenance treatment (MMT) clinics. This study used the baseline data from a randomized controlled trial conducted in 68 MMT clinics in five provinces in China. Service providers’ turnover intention, perceived risk at work, job satisfaction, years working in the clinic as well as sociodemographic characteristics were collected in the assessment. A logistic mixed-effects model was used to identify factors associated with providers’ turnover intention. Approximately one-third of these 418 service providers intended to change their job in this study. The findings of regression analysis showed that perceived risk at work was positively associated with the turnover intention (OR = 1.28; 95% CI: 1.17, 1.41) and job satisfaction was negatively related to the turnover intention (OR = 0.97; 95% CI: 0.95, 0.99). Study findings highlighted the importance of addressing service providers’ perceived risk at work and job satisfaction to reduce turnover intention. Intervention strategies that focus on occupation safety and job satisfaction could be integrated into current training programs to maintain a stable workforce in the MMT programs. This trial was registered at ClinicalTrials.gov. Registration date: January 4, 2013. Identifier: NCT01760720. Link: https://clinicaltrials.gov/ct2/show/NCT01760720

κ Opioid Receptor 1 Single Nucleotide Polymorphisms were Associated with the Methadone Dosage.

Background: Heroin use disorder (HUD) is a complex brain disease that includes multiple phenotypes. Heroin acts primarily as a mu-opioid receptor (OPRM1) agonist. The κ opioid receptor 1 (OPRK1) is critically involved in abstinence and remission. Multiple studies confirm that the OPRM1 and OPRK1 genes are associated with HUD. However, their relationship with the addictive phenotype is still unclear. This study was designed to identify the genetic polymorphisms within OPRM1 and OPRK1 with six HUD phenotypes. Methods: A total of 801 patients with HUD were recruited from the Methadone Maintenance Treatment Program in Xi'an. We identified eight potential functional single nucleotide polymorphisms (SNPs) in the two genes that were genotyped using SNaPshot SNP technology. We then performed a case-control association analysis, investigated particular disease phenotypes, and assessed the extent of epistasis among the variants of the two genes. Results: The OPRK1 rs3802279, rs3802281, and rs963549 genotypes were significantly associated with methadone dosage analyzed by Pearson's chi-square test or binary logistic regression to correct for covariates. The rs3802279 CC, rs3802281 TT, and rs963549 CC genotype carriers required a lower methadone maintenance dose per day. Multifactor dimensionality reduction analysis indicated strong interactions between sex and OPRK1 rs963549. The results of the OPRM1 genotyping did not reveal any associations with the various HUD phenotypes. Conclusion: These findings support an important role of the OPRK1 polymorphism in determining the daily methadone dose and may guide future studies in identifying additional genetic risk factors for HUD.

Factors Influencing Client Retention in Methadone Maintenance Treatment Clinics in the Kathmandu Valley

Introduction: Methadone maintenance treatment program is one of the accepted form of treatment modalities for opioid dependence individuals in Nepal. Retention in the treatment represents the assessment of the effectiveness of the treatment program. The aim of this study was to find out the factors associated with the retention of clients in the Methadone maintenance clinics in the Kathmandu Valley.&#x0D; Material and Method: A total of 84 clients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The patients were followed up at the end of 6 months and retention rate was calculated. The patient was considered ‘drop out “if the patient did not take methadone for 7 consecutive days. Group differences between ‘dropout’ and non-dropout (retained) clients on MMT program were tested using t-test and Chi-square test for continuous variables and categorical variables respectively.&#x0D; Results: At the end of 6 months 63 patients still remained in the MMT program, so the retention rate was found to be 75% in the study. The factors associated with the retention included higher dosage of methadone (p&lt;0.001), history of multiple substance intake (p=0.004) and previous treatment history of the drug related problems (p=0.015).&#x0D; Conclusion: Opioid dependent individuals may stick to the MMT program for longer durtion if they are offered with higher dosage of Methadone and special attention should be given to the patients with history of poly substance abuse and prior treatment history to prevent their relapse.

Changes in the Quality of Life of Outpatients in Methadone Maintenance Treatment Clinics in Kathmandu Valley

Introduction: Methadone maintenance treatment (MMT) is widely accepted treatment option for the opioid dependent individuals. The evaluation of the quality of life represents the assessment of the effectiveness of the treatment program. The study aimed to explore the impact of MMT program on clients’ quality of life in the first 6 months of treatment. Methods: A total of 63 patients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The semi-structured pro forma was filled up. To assess quality of life, WHO Quality of Life questionnaire (WHOQOL-BREF, 26-item version) was used. The tool was used to assess the quality of life at the baseline and after 6 months of enrollment in MMT program. Results: Following 6 months of methadone maintenance treatment of opioid dependent individuals, significant improvements (P&lt;0.001) were observed in all measured domains of quality of life i.e. physical, psychological, environmental and social. The least improvement was noted in the social domain. Conclusion: Methadone maintenance treatment is helpful in improving the quality of the life of the opioid dependent individuals in MMT clinics.

Changes in the Quality of Life of Outpatients in Methadone Maintenance Treatment Clinics in Kathmandu Valley

Introduction Methadone maintenance treatment (MMT) is widely accepted treatment option for the opioid dependent individuals. The evaluation of the quality of life represents the assessment of the effectiveness of the treatment program. The study aimed to explore the impact of MMT program on clients’ quality of life in the first 6 months of treatment.&#x0D; MethodsA total of 63 patients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The semi-structured pro forma was filled up. To assess quality of life, WHO Quality of Life questionnaire (WHOQOL-BREF, 26-item version) was used. The tool was used to assess the quality of life at the baseline and after 6 months of enrollment in MMT program.&#x0D; ResultsFollowing 6 months of methadone maintenance treatment of opioid dependent individuals, significant improvements (P&lt;0.001) were observed in all measured domains of quality of life i.e. physical, psychological, environmental and social. The least improvement was noted in the social domain.&#x0D; ConclusionMethadone maintenance treatment is helpful in improving the quality of the life of the opioid dependent individuals in MMT clinics.

The Decade-Long Chinese Methadone Maintenance Therapy Yields Large Population and Economic Benefits for Drug Users in Reducing Harm, HIV and HCV Disease Burden.

Objectives: We aimed to conduct a comprehensive evaluation of the population impact of methadone maintenance treatment (MMT) for its future program planning.Methods: We conducted a literature review of the effects of MMT in China on HIV and HCV disease burden, injecting, and sexual behaviors and drug-related harm during 2004–2015. Data synthesis and analysis were conducted to obtain the pooled estimates of parameters for a mathematical model which was constructed to evaluate the effectiveness and cost-effectiveness of the program.Results: Based on a review of 134 articles, this study demonstrated that MMT is highly effective in reducing crime-related, high risk sexual, and injecting behaviors. The model estimated US$1,037 m which was invested in MMT from 2004 to 2015 has prevented 29,463 (15,325–43,600) new HIV infections, 130,563 (91,580–169,546) new HCV infections, 10,783 (10,380–11,187) deaths related to HIV, HCV and drug-related harm, and 338,920.0 (334,596.2–343,243.7) disability-adjusted life years (DALYs). The costs for each prevented HIV infection, HCV infection, death, and DALY were $35,206.8 (33,594.8–36,981.4), $7,944.7 ($7,714.4–8,189.2), $96,193.4 (92,726.0–99,930.2), and $3,060.6 ($3,022.0–3,100.1) respectively.Conclusion: The Chinese MMT program has been effective and cost-effective in reducing injecting, injecting-related risk behaviors and adversities due to HIV/HCV infection and drug-related harm among drug users.

“Take Charge, Get Cured”: Pilot testing a targeted mHealth treatment decision support tool for methadone patients with hepatitis C virus for acceptability and promise of efficacy

Hepatitis C (HCV) is a highly prevalent infection in current and former IV drug users. Current estimates indicate that over 70% of those in methadone maintenance treatment programs (MMTs) have HCV, but only 11% have initiated treatments despite availability of new treatments that are easily tolerated and can cure infection in about 8 weeks. We conducted a pilot randomized trial at four Philadelphia, PA MMTs to test acceptability, feasibility and promise of efficacy of our “Take Charge, Get Cured” mobile health (mHealth) treatment decision tool, developed through extensive formative work that included methadone patients' input and targeted directly to concerns of methadone patients with Hepatitis C (HCV). We compared its impact on perceptions and knowledge about HCV and HCV treatment, decisional conflict, intention to and actual initiation of HCV care to a web-based Cochrane-reviewed, non-targeted HCV decision tool. Subjects (n = 122) were randomized, administered baseline questionnaires, interacted with the targeted or non-targeted decision tool on an electronic tablet, and answered post-test questions. After 3-months subjects (n = 93; 76%) were surveyed for follow up. “Take Charge, Get Cured” users were more likely to report the tool helped with decision making and demonstrated greater improvement in knowledge, decisional conflict, and intention to be treated for their HCV infections than users of the non-targeted decision tool. They were significantly more likely to say the targeted tool was helpful and that they would recommend it to others. At three month follow up, targeted group participants were more likely to say the tool helped them make a better decision about treatment and prepared them to talk to their doctor about what matters most to them about treatment. No differences were seen in actions to initiate HCV care, but more targeted group participants reported talking to their doctors about HCV treatment. Results indicate a highly targeted mHealth decision tool is an important strategy to affect perceptions and knowledge of HCV treatment that lowers decisional conflict about initiating treatment, key components in decision making. We believe this highly acceptable and feasible intervention could be utilized in clinical settings to address the important barriers to initiating HCV treatment in a vulnerable population.

Conformations and interactions comparison between R- and S-methadone in wild type CYP2B6, 2D6 and 3A4

Abstract Methadone is a morphine-substitute drug in methadone maintenance treatment (MMT) program to treat patients with opioid dependency. However, the methadone clinical effects are depending on the methadone metabolism rates that vary among the patients with genetic polymorphism of cytochrome P450s (CYPs). Our previous study showed methadone has different binding affinity due to the polymorphisms in CYP2B6, CYP2D6 and CYP3A4 that could contribute to the methadone metabolism rate. In this work, the conformation and interactions of R- and S-methadone in wild type CYP2B6, CYP2D6 and CYP3A4 were further studied in order to understand behaviour of R- and S-methadone at the CYP binding site. Clustering analysis showed that the conformation of R- and S-methadone in CYP2B6 are most stable, thus could lead to a higher efficiency of methadone metabolism. The conformation fluctuation of methadone in CYP2D6 could due to relatively smaller binding pocket compared with CYP2B6 and CYP3A4. The binding sites volumes of the studied CYPs were also found to be increased upon the binding with methadone. Therefore, this might contributed to the interactions of both R- and S-methadone in CYPs were mainly by hydrophobic contacts, van der Waals and electrostatic interactions. In the future, should an inhibitor for CYP is to be designed to prolong the prolonged opioid effect, the inhibitor should cater for single CYP isozyme as this study observed the behavioural differences of methadone in CYP isozymes. Graphical Abstract:

Continued Use of Illicit Substance among Methadone Treatment Patients in Primary Health Care Clinics in East Coast Region of Malaysia

ABSTRACTStudies investigating the continued use of illicit substances among patients in Methadone Maintenance Treatment (MMT) programs are limited. This study aimed to determine the association of methadone dose with illicit substance misuse among MMT patients in East Coast Region of Malaysia. Validated substance use pattern questionnaire was used to fulfill the study objectives. 55% (n = 130/237) of the respondents received a ≤ 50 mg methadone dose daily. Low methadone dose (≤50 mg/daily) was associated with opiate use in the last 30 days, while high methadone dose (>50 mg/daily) was associated with methamphetamine injection in the last 30 days (OR: 1.97; 1.01–3.82; p< .044). An optimum methadone maintenance dose is deemed appropriate to reduce use of illicit opiates, and necessary psychosocial intervention to reduce methamphetamine injection behavior is suggested.

Suicide Ideation and Drug Craving in Patients Under Methadone Maintenance Treatment (MMT)

Background: Currently, methadone maintenance treatment (MMT) is a well-known method, for treating opiate dependence in many parts of the world. Despite being in MMT programs, craving has an important role in relapses. Substance abusers are at high risk of suicide, and suicidal ideation is a key factor for predicting suicide attempts. Objectives: This study was conducted to determine suicide ideation and drug craving and their predictors in patients under MMT. Patients and Methods: This cross-sectional study was conducted on 234 patients under MMT at Baharan Psychiatric Center of Zahedan, Iran. Participants completed a set of self-report standard questionnaires, including Beck’s Depression Inventory, Beck’s Anxiety Inventory, Borderline Personality Scale, Social Support Appraisals Scale, the Communication Skills Inventory, and Craving Inventory. Bivariate correlation analyses and linear regression model were employed to identify the predictors of suicide ideation and craving. Results: Occupational status, suicide attempts, suicide in the family, symptoms of borderline personality, and communication skills were significant predictors for suicide ideation. The duration of MMT and borderline personality symptoms were also important determinants of craving. Conclusions: Since people under MMT have high suicide ideation and it can be a risk factor for suicide attempts, it is suggested to focus on early detection of suicide ideation. Mental health staff must pay attention to the risk factors for craving because it could become the cause of drop-out during treatment.

Improvement of Methadone Maintenance Treatment (MMT) Process Through Development and Implementation of Methadone Dispenser

Abstract Methadone is a controlled drug and can be prescribed by an authorized person in charge, under the direction of medical practitioners, for particular patients, to cure their addiction to opioid substances. The development and evaluation of a methadone dispenser present a prototype solution for solving the current manual methadone dispensing problems, which are prone to human error, with the implementation of the methadone maintenance treatment (MMT) program at the same time to increase public awareness about this program. In the current study, the performance of a methadone dispenser is evaluated by investigating the simulation analysis, feasibility, and efficiency of the device as compared to the manual technique. For testing purposes, methadone syrup was replicated with sugar solution of 66.6 g/50 mL at 25°C with a dynamic viscosity of 36.680 mPa.s. Thus, it was quantified that the time taken to dispense the sugar solution by using the methadone dispenser has shown a significant improvement of 81.40 % time reductions as compared to the manual technique. The low repeatability percentage of the methadone dispenser by 1.64 % contributes to a high precision device that is reliable enough to be implemented in the MMT program with a dispensing accuracy increment of 3.87 %, as compared to the manual technique. The findings suggest that the methadone dispenser is reliable and feasible and contributes to error reduction for implementation in the MMT program with approximately ≈ 97 % efficiency.

Polysubstance Use among Patients Enrolling in Methadone Maintenance Treatment Program in a Vietnam Province with Drug-Driven HIV Epidemic.

Methadone maintenance treatment (MMT) has been scaled up significantly in recent years. This study aimed to investigate the pattern of polysubstance use in 395 MMT patients and its contextualized associated factors. A cross-sectional study was performed in three outpatient MMT clinics in Nam Dinh Province. Multivariate Poisson regression was used to identify factors associated with polysubstance use status. The mean MMT duration and the current MMT dose was 3.3 years and 69.2 mg, respectively. Among participants, 24.8% reported daily alcohol use, 68.6% smoked regularly, and 6% used illicit drugs. Peer pressure and MMT suboptimal adherence were found to associate with continual usage of drugs (47.8%). Participants who lived with a spouse/partner, were self-employed, and smoked were more likely to drink alcohol. Those who drink were also more likely to smoke, and vice versa. Recommendations for policymakers include community-based education and promotional programs aiming to decrease substance usage in the community as well as encouraging and supporting the private health sector in establishing private MMT services and clinics. Further longitudinal studies on polysubstance usage among MMT patients should also be conducted.

Increases in body mass index and cardiovascular risk factors during methadone maintenance treatment.

This study describes changes in weight and cardiovascular risk factors over time among individuals enrolled in methadone maintenance treatment for opioid use disorder. Demographic and clinical predictors of weight gain were also evaluated. This study was a retrospective chart review evaluating data over a period of 3 years. Medical records of individuals enrolled in an academic research outpatient methadone maintenance treatment program were reviewed. Seventy-four individuals who were admitted and retained in methadone maintenance treatment for at least 3 consecutive years were included. Annual weight was assessed by calculating body mass index (BMI). Changes over time in cardiovascular risk factors of hypertension, diabetes, and hypercholesterolemia were also assessed. The percentage of patients categorized as overweight, obese, or morbidly obese BMI increased from 42 percent (n = 31) at admission to 76 percent (n = 56), 82 percent (n = 61), and 88 percent (n = 65) at 1, 2, and 3 years post-admission, respectively. Hypertension, diabetes, and hypercholesterolemia also tended to increase following admission. BMI increases tended to be greater for those with a higher dose of methadone, as well as for females and Black/African American individuals. No other predictors of weight gain were identified. These data indicate that methadone maintenance treatment is associated with clinically meaningful weight gain and increases in cardiovascular risk factors. Given the importance of methadone maintenance for treatment of opioid use disorder, future research should examine additional predictors and potential mechanisms of weight gain among methadone patients and develop tailored interventions including nutritional knowledge and lifestyle recommendations.