Methadone Maintenance Treatment Users Research Articles

Effects of treatment status and life quality on anxiety in MMT patients

BackgroundAnxiety, an important factor that affects the therapeutic effect and preservation rate of methadone maintenance treatment, has a high prevalence among MMT patients. This study aims to investigate the effects of treatment status and life quality on anxiety in MMT patients.MethodsOne hundred and Seventy-seven methadone maintenance treatment users in Guangzhou, China were evaluated. The socio-demographic, duration and MMT-related characteristics were documented. Anxiety level and quality of life were evaluated by Beck Anxiety inventory (BAI) and the Quality of Life-Drug Addiction (QOL-DA) respectively. The correlation between different factors and BAI score was also analyzed.ResultsThe BAI total score and the QOL-DA score were 7.1±8.2, 163.5±21.4 respectively. 30.5% of the subjects showed mild to severe anxiety. Treatment interruption and QOL-DA score had strong correlations with the score of BAI, with correlation coefficients of 0.17 and − 0.08 respectively.ConclusionsAnxiety symptoms were commonly presented in MMT patients. Treatment interruption and quality of life are two major factors affecting anxiety of MMT patients.

Motor Vehicle Accident Risk after Methadone Use: A Population-Based Study

Background: Opioid dependence, a major global public health concern, can be alleviated through methadone maintenance treatment (MMT). However, MMT possibly increases motor vehicle accident risk. The aim of this study was to determine motor vehicle accident risk in MMT users. Methods: We performed preliminary estimation of motor vehicle accident incidence rates in Taiwan. In this population-based retrospective cohort study with frequency-matched controls, adult opiate users receiving MMT and not receiving MMT (control) were identified at a 1:2 ratio by linking data from several nationwide administrative registry databases. All individuals were followed for motor vehicle accident events. Data were adjusted for potential covariates and assessed using Kaplan–Meier and Cox proportional hazard model analyses. Findings: From 2009 to 2016, the crude incidence rate of motor vehicle accidents was the lowest in the general adult population, followed by that in adult opiate users, and it was the highest in adults receiving MMT. Among opiate users, motor vehicle accident incidence rates were significantly higher in those receiving MMT than in those not receiving MMT (adjusted hazard ratio [aHR] 2.75, 95% CI 1.87–4.04; p<0.001). Kaplan–Meier curves of the incidence of motor vehicle accidents differed significantly between groups (log-rank test p<0.001), with a significant decline during the first 90 days of follow-up. Rural area residents had a higher motor vehicle accident risk than did urban area residents (aHR 1.56, 95% CI 1.05–2.32; p=0.029). Interpretation: Drivers receiving MMT have an increased motor vehicle accident risk, particularly during the first 90 days of MMT. These findings should be considered for motor vehicle accident prevention in opiate users receiving MMT. Funding Taiwan Food and Drug Administration. Funding Statement: This study was supported by 2 grants from the Taiwan Food and Drug Administration (TFDA) (MOHW106-FDA-D-114-000671 and MOHW107-FDA-D-114-000636). Declaration of Interests: Authors have no potential conflicts of interest to disclose. Ethics Approval Statement: The study was approved by the Institutional Review Boards (TSMH IRB No.: 17-010-B1 and 18-049-B); the need for written informed consent was waived because we used deidentified information from the databases.

Efficacy of a Positive Psychological Intervention in Improving Mental Health Status Among Methadone Maintenance Treatment Users in Guangzhou, China—a Randomized Controlled Trial

Mental health problems such as depression and anxiety are highly prevalent among people who use drugs (PWUD). The positive psychological intervention (PPI) is a newly developed method which has been applied successfully in the general populations to improve mental health status. In this study, we designed a randomized controlled trial (RCT) to test the feasibility and efficacy of the PPI in improving mental health status of PWUD attending methadone maintenance treatment (MMT). A total of 140 MMT users were randomly allocated into the intervention group (n = 70) which carried on the intervention (documenting “Three Good Things” every day for 2 weeks) and the control group (n = 70) which received booklets about mental health. Baseline, 2-week, 1-month, and 3-month follow-up interviews were conducted. Generalized estimating equations for repeated measurements were used to examine the efficacy of intervention. Data showed that at baseline, the prevalence of probable depression was 75.4% and 73.9% in the two groups respectively, while the prevalence of anxiety was 56.5% and 45.7%, and the prevalence of low satisfaction with life was 70.0% and 52.2%. About 60% of the intervention group members adhered to at least 50% of intervention. In the multivariate model, PPI was not significantly associated with probable depression (ORa = 0.75, 95% CI 0.27–2.12), anxiety (ORa = 0.99, 95% CI 0.47–2.06), or low satisfaction with life (ORa = 1.54, 95% CI 0.65–3.65). Efficacy of PPI was not observed in this study while PPI intervention is potentially feasible among some PWUD. Efficacy of PPI could be further test in studies with other innovative ways and longer intervention period.

EVALUASI PELAKSANAAN PROGRAM TERAPI RUMATAN METADON PADA PECANDU NARKOBA JENIS PUTAW DI KOTA SEMARANG TAHUN 2016

Methadone maintenance treatment (MMT) is aimed to reduce the harmful effects of injecting drug use. Since the first Puskesmas Poncol opened this program in 2010, there were 50 users of MMT. Currently users of MMT were 11 people, 2 people have died, no patient has recovered, and 36 others dropped out. Those did not recover, but dropped out with reasons and information that were not known by the officer. MMT is a strategic key of HIV/ AIDS prevention for injecting drug users. However, in the implementation Puskesmas Poncol was lost most of active MMT users. The research aimed to know the implementation of MMT which includes input, process, and output on heroin addict in Puskesmas Poncol. This research was qualitative research supported by quantitative data. Data collection used in-depth interviews, observation, and documentation. The result of the research showed that the service of MMT in Puskesmas Poncol was still many weaknesses, from input aspect (untrained human resources), process (methadone planning, organizing, and dose arrangement have not been well implemented), and output (services have not been evaluated).

Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou, China

ABSTRACTA considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor–Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD = 15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, ORu = 0.96 and 0.96, p < .01). In multivariate models adjusting for both background and other psycho-social factors, resilience was independently associated with probable depression (ORa = 0.97, 95% CI: 0.93–0.99) and anxiety (ORa = 0.96, 95% CI: 0.94–0.99). Resilience was independently associated with depression and anxiety. As resilience is changeable, interventions targeting mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.

Depression, suicidal ideation, and related factors of methadone maintenance treatment users in Guangzhou, China

ABSTRACTMental health problems are prevalent among drug users. Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction; however, there are few studies investigating depression, suicidal ideation, and their related factors among MMT users. In this cross-sectional study, 648 MMT users were recruited from six MMT clinics in Guangzhou, China. Data were collected through face-to-face interviews by trained interviewers. Of all participants, 270 (42.7%) exhibited probable depression (Depression Subscale of the Chinese short version of Depression, Anxiety, and Stress Scale (DASS-D), score ≥ 10) and 99 (15.3%) reported having suicidal ideation in the last six months. After adjusting for significant socio-demographic characteristics, all studied variables, including drug use history, social support, family support for MMT use, and satisfaction toward MMT services were significantly associated with both probable depression and suicidal ideation in the last six months. Furthermore, depression fully mediated the associations between drug use history, satisfaction toward MMT services, and suicidal ideation. In the final multivariate models, probable depression was associated with social support (OR = 0.88, 95% CI = 0.83–0.93) and satisfaction toward MMT services provided by doctors (OR = 0.59, 95% CI = 0.40–0.86), while for suicidal ideation, social support (OR = 0.85, 95% CI = 0.78–0.92) and probable depression (OR = 5.94, 95% CI = 3.39–10.42) were significant. The findings suggest that there are unmet mental health needs among MMT users. For countries with limited resources of psychological services, mental health care toward MMT users should be implanted into current health care settings and incorporate components such as social support, family's understanding of MMT, and service satisfaction.

Changes in resting EEG following methadone treatment in opiate addicts

ObjectiveThis study investigated the electrophysiological activity associated with methadone maintenance treatment (MMT). MethodsThe resting EEG spectrum of beta (14.5–30Hz), alpha (8–13Hz), theta (4–7.5Hz) and delta (1.5–3.5Hz) rhythm were measured in 32 patients undertaking chronic MMT, 17 opiate users and 25 healthy volunteers. Differences in the EEG components of each group were evaluated using a repeated measures Analyses of Variance (ANOVA). Post-hoc comparisons were Bonferroni corrected. ResultsOur results show that either patients undertaking MMT or active opiate users exhibited a significant increase in the power of beta and theta bands relative to healthy control subjects. However, the spectral power of patients undertaking MMT fell between that of current opiate users and healthy control subjects on many regional EEG measures. There was an inverse correlation between the power of beta or theta bands and cognitive performance. ConclusionThe abnormal neural electrical activity present in those still using illicit opiates might be reduced following MMT. SignificanceThe present findings provide further support for MMT of opiate dependence and demonstrates potentially positive effects of substitution treatment on brain function.

Evaluación del programa de mantenimiento con metadona del Hospital Mental de Risaralda

BackgroundPsychosocial care and methadone maintenance treatment (MMT) are the preferred strategies for the management of heroin addicts, but the results are still unsatisfactory, justifying the search and intervention of the factors influencing the response to treatment. MethodologyIn order to determine the contribution of demographic, clinical and genetic variables on serum concentrations and response to methadone, we investigated patients on MMT, who were receiving methadone in supervised and unchanged doses at least during the previous two weeks. The age, gender, body mass index (BMI), duration of heroin abuse, addiction to other drugs, criminal background, current daily methadone doses, time spent in the TMM, comorbidity and concomitant medication were recorded. Blood samples were taken for the determination of serum levels of racemic methadone and its R and S-enantiomers, and for typing of candidate alleles of POR, CYP2B6, ABCB1, GRIN1, OPRM1, SLC6A3, DßH and ARRB2 genes, all associated with the metabolism, tissue distribution and mechanism of action of methadone. Methadone quantification was by HPLC-DAD, and the detection of genetic markers by Real Time PCR and VNTR methods. ResultsA total of 80 subject volunteers were enrolled, with a mean age of 23.5 (5) years (86% male), all of them were addicts of multiple drugs, 60% with a criminal background, 5.1 (2.9) years taking heroin, and 5.3 (4) months on MMT, and taking a supervised dose of 41 (12) mg/day methadone. The (R), (S) and (R, S) methadone enantiomer trough plasma levels were, 84 (40), 84 (42), and 168 (77) ng/mL, respectively. All genotypes were in Hardy-Weinberg equilibrium. The two urine tests were negative for heroin in 61.3% (49/80) of the volunteers, the decline in cocaine/crack use was 83%, 30% of marijuana, and other psychoactives (inhalants, benzodiazepines, amphetamines) decreased to zero, while the consumption of snuff remained at 93.5% (75/80). Blood concentrations of racemic methadone and its enantiomers were significantly associated with the dose/day of the medication, but none of the other demographic, clinical or genetic variables impacted on serum levels of methadone. As for the results of the MMT, non-users and occasional users of heroin, as well as those who stopped taking other psychoactive drugs, and the ones who did not, were similar as regards the demographic, genetic and clinical variables. This included the blood metahdone concentrations, except for individuals who did not reduce their consumption of other psychoactives other than heroin, who had significantly (P=.03) higher blood levels of S-methadone, compared with those who did stop taking them. ConclusionsThere was a significant reduction in the consumption of heroin and other psychoactives, and social rehabilitation of patients. However, the extensive overlap between effective and ineffective doses of methadone suggests the presence of personal and social variables that transcend the simple pharmacological management. These probably need to be addressed more successfully from the psychosocial features, particularly as regards to identifying and overcoming relapse-trigger experiences, as well as certain features of the patient, such as their psychological distress level or their psychiatric disorders.

A Randomized Controlled Trial to Evaluate the Relative Efficacy of the Addition of a Psycho-Social Intervention to Standard-of-Care Services in Reducing Attrition and Improving Attendance Among First-Time Users of Methadone Maintenance Treatment in China

Although methadone maintenance treatment (MMT) is an important means of HIV control, MMT clinics commonly have high attrition rates. The randomized controlled trial investigated the relative efficacy of adding a psycho-social intervention to the standard-of-care MMT in reducing attrition and non-attendance among first-time newly admitted MMT users in China (n = 288). Social workers implemented this three-phase intervention that was based on a behavioral maintenance theory. It also involved participants' family members and rectified some MMT-related misconceptions. As compared to the control group, the intervention group showed significantly lower likelihood of attrition (HR = 0.55, 95% confidence interval 0.39-0.80), lower estimated probability of attrition at Month 12 (0.35 vs. 0.55), and higher median number of days of attendance (Month 6: 147 vs. 91 days, p < 0.001; end-date: 225 vs. 142 days, p < 0.001). Further psycho-social services and translational research are warranted.

Effectiveness of intervention services provided by social workers in methadone maintenance treatment clinics

To investigate the effectiveness of psychosocial services provided by social workers in reducing dropout rate and increasing treatment dosage in methadone maintenance treatment (MMT) users. From May in 2009 to April in 2010, 300 MMT users were recruited from three MMT clinics in Guangzhou, and were randomly allocated into the intervention group and the control groups. The control group (152 cases) received standard MMT services while the intervention group (148 cases) received additional services provided by social workers. Methadone dosage, dropout rate, perceptions toward MMT etc. were compared between the two groups. The 1-month dropout rate of the control and intervention groups were 19.7% (30/152) and 6.8% (10/148) (P < 0.05) respectively; the 6-month dropout rate of the control and intervention groups were 75.5% (115/152) and 50.7% (75/148) (P < 0.05) respectively. The intervention group had higher average treatment dosage than the control group ((56.0 ± 21.2) vs (64.4 ± 23.1) ml/d, (58.0 ± 24.0) vs (66.1 ± 26.6) ml/d, P < 0.05). At 1-month and 6-month, the intervention group had higher scores of MMT-related perception ((1.26 ± 0.68) vs (1.84 ± 0.95), (1.55 ± 0.83) vs (2.44 ± 1.23), P < 0.05), self-efficacy of maintenance ((3.68 ± 1.33) vs (4.20 ± 1.05), (3.80 ± 1.38) vs (4.43 ± 0.79), P < 0.05) and satisfaction toward MMT((4.08 ± 0.54) vs (4.15 ± 0.60), (4.01 ± 0.67) vs (4.31 ± 0.64), P < 0.05) as compared to the control group. The reverse was true for the score of negative experiences ((1.05 ± 0.86) vs (0.96 ± 0.92), (1.46 ± 0.87) vs (1.11 ± 1.07), P < 0.05). The psychosocial interventions provided by social workers were effective in reducing dropout rate, increasing treatment dosage and improving cognitions of MMT users.

Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999–2008

ObjectivesTo determine all-cause and specific-causes mortality, in the years 1999–2008, among opioid-dependent users treated at methadone maintenance treatment (MMT) clinics in Israel and to compare the obtained results with data from relevant studies worldwide. MethodThe records of patients treated at MMT units were linked to the nationwide database of causes of death. Information about the Israeli general population from the Central Bureau of Statistics was used for comparison to match sex and age to the cohort under study. Crude mortality rates (CMRs) per 100 persons per year (PY) and standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated. ResultsThe overall CMR for MMT users was 1.49/100 PY (CI 1.40–1.59) and was not associated with gender, age at entering MMT, ethnicity, and immigrant status. The leading causes of mortality were sudden/undefined death (0.31/100 PY, CI 0.26–0.35), overdose (0.22/100 PY, CI 0.17–0.27), and cancer (0.15/100 PY, CI 0.12–0.18). The MMT users were 12.2 times more likely to die from all causes than people from the general population. Overall, our estimates were comparable with the figures pooled from relevant studies. ConclusionsThe results suggest that the excess mortality of MMT users is associated with an increased morbidity, which alone or in combination with service-related risks, lead to worse outcomes.

Misconceptions toward methadone maintenance treatment (MMT) and associated factors among new MMT users in Guangzhou, China

The methadone maintenance treatment (MMT) program is scaling up in China, but little is known about drug users' cognitions of MMT. To investigate the prevalence and associated factors of MMT-related misconceptions, a totally of 300 newly admitted MMT users were interviewed in three MMT clinics in Guangzhou. Four statements were used to assess MMT-related misconceptions. The results showed that the majority of participants misconceived that MMT is intended primarily for detoxification (92.3%), that one could be completely detoxified and quit using methadone after using it for 2–3months (64.2%), that MMT is not a long-term or even lifetime treatment (77.9%); and that one should attempt to reduce its treatment dosage as methadone is harmful to one's health (84.3%); 48.5% of the respondents possessed all four types of misconceptions. Prior experience of methadone use in voluntary drug detoxification centers (OR=1.82 to 2.55, p<0.05) was associated with some misconception items, whilst being introduced by some peer drug users or community members to use MMT (versus not being introduced by anyone; OR=0.38 to 0.50, p<0.05), having taken up HIV voluntary counseling and testing prior to admission (OR=0.52, p<0.05), and a higher HIV-related knowledge level (OR=0.38, p<0.05) were associated with lower likelihoods for possessing some of the misconceptions. The findings suggested that MMT-related misconceptions were very prevalent among newly recruited MMT users in China. Misconceptions are potential factors causing drop-outs. Interventions targeting such misconceptions are greatly warranted.

Predictors of methadone maintenance treatment utilization in a multisite cohort of illicit opioid users (OPICAN)

Although methadone maintenance treatment (MMT) has been a primary treatment response to illicit opioid use in Canada for decades, analytical treatment data are scarce. Using data from the multisite OPICAN cohort of illicit opioid and other drug users repeatedly assessed between 2002 (baseline) and 2005 (last follow-up [FU]), we (1) longitudinally examined characteristics associated with MMT uptake between baseline and FU and (2) cross-sectionally compared drug use patterns between cohort participants in MMT ( n = 133) and those not in MMT ( n = 400) at the last FU through bivariate and multivariate analyses (stepwise logistic regression). Significant baseline predictors of MMT uptake emerging in the logistic regression model included injection drug, heroin, as well as alcohol use, housing status, and Quebec City as a site. Furthermore, lower prevalence levels of opioid (e.g., morphine and OxyContin) and nonopioid (e.g., cocaine and crack) drug use as well as lower frequency of heroin use days were observed among MMT users. This study highlights potential factors relevant for improved MMT uptake and illustrates possible reductions of drug use related to MMT.