Methadone Patients Research Articles

Stigma, Misunderstanding Among the Barriers to MAT Treatment

Stigma, Misunderstanding Among the Barriers to MAT Treatment

Testing a Neuro-Evolutionary Theory of Social Bonds and Addiction: Methadone Associated With Lower Attachment Anxiety, Comfort With Closeness, and Proximity Maintenance.

Evidence from non-human mammals for the involvement of the endogenous opioid system in prosocial behavior is reasonably extensive and robust; however, studies in humans are lacking. This study tests the neuro-evolutionary hypothesis that exogenous opiates, including morphine, heroine, and methadone, decrease separation anxiety and proximity by hijacking the neuro-peptide endogenous opioid system modulating social bonds. Participants were 486 subjects, 43% male, with ages between 18 and 62 years (M = 26.4; SD = 9.4), divided in three naturalistic groups: 1: addicts in drug-free treatment; 2: addicts in methadone programs; 3: normative non-clinical controls. Instruments: 1) Adult Attachment Scale (AAS) composed of three subscales: Anxiety about being rejected (α = 0.83), Comfort with Intimacy (α = 0.68), and Comfort Depending on Others (α = 0.70). 2) Caregiving Questionnaire composed of four subscales: Proximity Maintenance: (α = 0.83), Sensitivity: (α = 0.76), Controlling Caregiving (α = 0.77) and Compulsive Caregiving (α = 0.68). Results: Multivariate Analysis of Co-variance (MANCOVA) models were computed; gender, age, and education were included in the models. Methadone patients and drug-free treatment addicts were equivalent and reported significantly lower Comfort Depending on Others, Comfort with Intimacy, and Caregiving Proximity. However, methadone users reported significantly lower Anxiety about being rejected than drug-free addicts and were equivalent to non-clinical controls. In addition, correlations between the methadone intake dose and the questionnaires’ scales showed that dose was significantly and negatively correlated with Comfort with Closeness (rs = −0.36; p < 0.01) and with Caregiving Proximity (rs = −0.28; p < 0.05).

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.

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

Objective: 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. Design: This study was a retrospective chart review evaluating data over a period of 3 years. Setting: Medical records of individuals enrolled in an academic research outpatient methadone maintenance treatment program were reviewed. Patients: Seventy-four individuals who were admitted and retained in methadone maintenance treatment for at least 3 consecutive years were included. Outcome measures: 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. Results: 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. Conclusions: 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.

Pharmacogenetic role of dopamine transporter (SLC6A3) variation on response to disulfiram treatment for cocaine addiction.

Disulfiram has been beneficial in treating cocaine addiction in several studies. Patients with two SLC6A3 (DAT1) rs28363170 10-repeat alleles who have with genetically high dopamine transporter (DAT) levels may benefit from increased dopamine levels resulting from disulfiram treatment. After stabilization for 2 weeks on methadone, 70 cocaine and opioid codependent patients were randomized into disulfiram and placebo groups for 12 weeks of treatment. We genotyped the SLC6A3 (DAT1) 40 bp 3'-untranslated region variable number tandem repeat variant and evaluated its role in moderating disulfiram efficacy for cocaine dependence. Among the 10,10-repeat genotype group, cocaine-positive urines dropped from 78% to 48% and from 80% to 75% among the 9-repeat carrier group in the disulfiram group (P = 0.0001, with an effect size of 0.09). No difference was observed in cocaine-positive urines in the placebo group between the 10,10-repeat genotype and the 9-allele carrier patients. We found that patients with genetically higher DAT levels had better treatment outcomes with disulfiram pharmacotherapy of cocaine dependence than those with lower DAT levels. (Am J Addict 2019;28:311-317).

Relevance of CYP2B6 and CYP2D6 genotypes to methadone pharmacokinetics and response in the OPAL study.

Our study aimed to evaluate the impacts of the cytochrome P450 (CYP) 2B6-G516T and CYP2D6 genetic polymorphisms on pharmacokinetic and clinical parameters in patients receiving methadone maintenance treatment. Opioid PhArmacoLogy (OPAL) was a clinical survey of the sociodemographic characteristics, history and consequences of pathology associated with methadone maintenance treatment response and current addictive comorbidities. A subgroup of 72 methadone patients was genotyped. When comparing the three CYP2B6 genotype groups, the methadone (R)- and (S)-methadone enantiomer concentrations/doses (concentrations relative to doses) were different (P = .029, P = .0019). The CYP2D6 phenotypes did not seem to be relevant with regard to methadone levels. On multivariate analysis, neither the CYP2B6 genotype nor the CYP2D6 phenotype explained the (R)-methadone concentration/dose values (P= .92; P = .86); the (S)-methadone concentration/dose values (P = .052; P = .95 [although there was a difference between the TT group and GT and GG groups {P = .019}]); or opiate cessation (P = .12; P = .90). The genotyping of CYP2B6 G516T could be an interesting tool to explore methadone intervariability.

Struggling to achieve a ‘normal life’: A qualitative study of Vietnamese methadone patients

Background:Methadone maintenance treatment, initially introduced in Vietnam for HIV harm reduction, has marked a significant switch in the country’s drug policy – from addiction as a moral issue to addiction as a brain disease. After the some initial outstanding achievements, the programme is facing a high dropout rate that threatens both goals of HIV prevention and drug treatment. This sociological study, as part of an HIV intervention research project, explores the challenges and opportunities that individuals who use drugs are faced with in relation to addiction treatment. Methods:A qualitative study among drug users with and without methadone maintenance treatment experiences recruited by peer outreach workers. We conducted 58 in-depth interviews and 2 focus groups between 2016 and 2017. Results:The start of treatment brought about significant feelings of success as heroin use was no longer compulsive. However, being in treatment programmes is also challenging with respect to continuing the recovery process. Barriers to retention include a popular fear of methadone as another harmful drug, a feeling of dependence related to the current practices of methadone treatment programmes and a poor therapeutic relationship. In the face of such challenges, the two major motivations that keep patients in care come from the desire to completely break up with heroin and the pursuit of family happiness. Conclusion:The current practices of methadone programmes pose challenges to patients’ recovery efforts from addiction and threaten treatment retention. Prompt interventions are needed to help Vietnam attain its objective of providing better care for larger vulnerable populations.

Medication Treatment With Methadone or Buprenorphine: Differential Reasons for Premature Discharge.

Medication treatment with methadone or buprenorphine has shown demonstrated effectiveness for opioid dependence; while premature discharge is associated with adverse outcomes. Specific reasons for premature discharge generally fall into 2 broad categories (ie, patient- and program-initiated). Previous studies have typically failed to distinguish between different types of discharge reasons among patients who leave treatment early. This study sought to determine whether type of medication was associated with differential discharge reasons among medication treatment patients who were prematurely discharged. Data were derived from electronic health records for 5486 patients prematurely discharged from 41 for-profit licensed opioid treatment programs in the United States from 2012 to 2013. All patients were treated with methadone or buprenorphine. Patients were studied through retrospective chart review until premature discharge. Buprenorphine patients who left treatment prematurely were 2.18 times (95% confidence interval [CI] 1.89-2.53) more likely to be discharged against medical advice relative to methadone patients after controlling for intake differences. Methadone patients were 1.76 times (95% CI 1.47-2.10) more likely to be administratively discharged after adjustment for covariates. Further research is warranted to determine whether individually-tailored strategies may improve retention for certain patients based on medication. Ongoing review of program rules and policies may benefit methadone patients, who are nearly twice as likely to be discharged for an administrative, program-initiated reason. Strategies including contingency management, motivational incentives, and psychoeducation regarding the advantages of retention may benefit buprenorphine patients who are over 2 times more likely to leave treatment early due to a patient-initiated reason.

Effectiveness of Methadone Maintenance Therapy (MMT) and Life Style Improvement Among Opiate Dependent Patients Registered

In Malaysia, drug addiction has been a big threat since 1983.As of by latest statistic by National Anti-Drug Agency in 2016, the number of drug abusers in Malaysia was 30846.Acknowledging the importance of drug abuse and relapse as a public health issue, Malaysian government had implemented Harm Reduction Programme .Under this programme, Methadone Maintenance Therapy (MMT) was launched in Oct 2005. This study was undertaken to evaluate the effectiveness of MMT programme among opiate dependent individuals in their daily life. In this study, 100 individuals from the Ministry of Health (MoH), Klinik Kesihatan Bayan Lepas (Bayan Lepas Health Clinic) and Agensi Anti-Dadah Kebangsaan (National Anti-Drug Agency) in Telok Bahang were involved. The subjects were interviewed with WHOQOL BREF questionnaires before joining the MMT programme and also after minimum 4 months of joining MMT. Results obtained were used for comparing life style implications among methadone patients before and after joining the MMT programme. Subjects were predominantly of Malay ethnicity (82%). Subjects were mostly aged between 51 to 60 years old (34%). Paired t-test was done on the WHOQOL scores at baseline (before MMT) and after minimum of 4 months enrolment for all four domains. Each domain showed significant improvement in QOL (P<0.05).The highest improvement was shown in the psychology domain with the mean value increment of 15.13±17.49. Physical domain showed the least improvement with the mean value of 9.39±16.21.This study has proven that MMT have highly contributed to improvement of quality of life among MMT clients in Klinik Kesihatan Bayan Lepas and AADK Telok Bahang. DOI : http://dx.doi.org./10.17576/JSKM-2019-1701-07

Perceptions of Barriers and Benefits of HCV Treatment and Correlates to Treatment Intention in Methadone Patients.

While most methadone maintenance treatment (MMT) patients have hepatitis C (HCV), less than 11% initiate treatment. The objective of this study was to assess this population's perceptions of HCV treatment. We surveyed 100 HCV+ MMT patients from four urban programs, asking scaled attitude scores about factors that may affect treatment decisions. Using bivariate and ordinal regression methods, results indicated that while education level and previous discussion about treatment with providers were associated with treatment initiation interest, age, race, gender, insurance type, difficulty paying for health care, and time since screening were not. Those who (a) believed HCV treatment is easy to take and cures quickly, (b) have had positive interactions with physicians, and (c) feel they have had enough HCV education were more likely to indicate treatment willingness. Interventions must emphasize positive treatment attitudes and not only focus on structural barriers to move HCV+ MMT patients towards initiating care.

Methadone Patients Satisfaction with Quality of Life - A Clinical Correlation

Methadone Patients Satisfaction with Quality of Life - A Clinical Correlation

The Effect of Patients’ Characteristics and the Dosage of Methadone Maintenance on Retention of Methadone Therapy in H. Adam Malik General Hospital, Medan

Background: The maintenance phase in methadone maintenance therapy required a long time un­til the patient was declared recovered, so that it often caused saturation and results in high drop­out rates. Therapy retention or survival of patients in the process of therapy was one indicator of the success of this methadone therapy. This study aims to determine the effect of patient charac­te­ris­tics and methadone maintenance therapy dose on the retention of methadone therapy at H. Adam Malik General Hospital Medan. Subjects and Method: This study used a cross sectional design and was carried out at H. Adam Malik General Hospital in Medan. The number of samples in this study was the total population of 63 patients in the maintenance phase January 2017 to January 2018. The dependent variable was the retention of methadone therapy and the independent variables included age, education level, ma­rital status, work status, domicile, and average maintenance dose even. The data in this study were obtained from the medical record data of maintenance phase methadone patients and the data analysis was done using multiple logistic regression tests. Results: The results showed that the average maintenance dose had an effect on retention of me­tha­done therapy (OR = 5.94, 95% CI 1.06 to 33.18, p = 0.042). Conclusions: The maintenance dose of ≥60 mg affects the retention of methadone therapy 6 times higher than the dose of <60 mg. Keywords: Therapy retention, patient characteristics, maintenance doses Correspondence: Dian Natalya Simangunsong, Master’s Program in Public Health of Uni­ver­si­tas Sumatera Utara, Jl. Jahe 7 No. 14 Simalingkar A, Medan Tuntungan District, Medan, Ema­il: dian_natalia2006@yahoo.co.id. Mobile: 0821-1133-5324 Indonesian Journal of Medicine (2019), 4(2): 176-182 https://doi.org/10.26911/theijmed.2019.04.02.11

Underdosing of methadone still a concern in OTPs, new national data indicate

A significant proportion of methadone patients still are not receiving daily dosing levels that conform to evidence‐based standards of practice, according to data in a new study published in the Journal of Substance Abuse Treatment. The study's lead researcher, who has looked at this topic over a span of nearly 30 years, believes that even within the nation's opioid treatment programs (OTPs), stigma among some professionals toward use of medication‐assisted treatment (MAT) contributes to dosing that may prove too low to encourage treatment retention and reduce illicit drug use.

Replication of the pharmacogenetic effect of rs678849 on buprenorphine efficacy in African-Americans with opioiduse disorder.

Many patients with opioid use disorder do not have successful outcomes during treatment but the underlying reasons are not well understood. An OPRD1 variant (rs678849) was previously associated with methadone and buprenorphine efficacy in African-Americans with opioid use disorder. The objective of this study was to determine if the effect of rs678849 on opioid use disorder treatment outcome could be replicated in an independent population. Participants were recruited from African-American patients who had participated in previous studies of methadone or buprenorphine treatment at the outpatient treatment research clinic of the NIDA Intramural Research Program in Baltimore, MD, USA between 2000 and 2017. Rs678849 was genotyped retrospectively and genotypes were compared to urine drug screen results from the previous studies for opioids other than the one prescribed for treatment. Genotypes were available for 24 methadone patients and 55 buprenorphine patients. After controlling for demographics, the effect of rs678849 genotype was significant in the buprenorphine treatment group (RR = 1.69, 95% confidence interval (CI) 1.59–1.79, p = 0.021). Buprenorphine patients with the C/C genotype were more likely to have opioid-positive drug screens than individuals with the C/T or T/T genotypes, replicating the original pharmacogenetic finding. The effect of genotype was not significant in the methadone group (p = 0.087). Thus, genotype at rs678849 is associated with buprenorphine efficacy in African-Americans being treated for opioid use disorder. This replication suggests that rs678849 genotype may be a valuable pharmacogenetic marker for deciding which opioid use disorder medication to prescribe in this population.

Iranian Female Methadone Patients and the Perceived Educational Needs Related to Human Immunodeficiency Virus.

BackgroundIranian female methadone patients are at risk of human immunodeficiency virus (HIV) due to involvement in high-risk sexual behaviours and/or needle sharing. The present study aimed to explore the perceived educational needs related to HIV among a group of Iranian female methadone patients.MethodsThe research design was qualitative and the participants were sampled purposively. Semi-structured interviews were conducted with 34 women and 19 clinicians in Sari, Mashhad, and Tehran, Iran. Then, qualitative content analysis was implemented.FindingsThe emergence of three major themes and six minor themes was revealed. Women expressed a need to increase their knowledge including women-specific pathophysiology and disease progression and the modes of the virus transmission and prevention. Women also expressed a need to enhance their knowledge and skills related to the physical management of the virus including self-care and reproductive health. Other themes included perceived psychosocial needs including removing stigma and access to resources in the community.ConclusionWomen reported a wide range of educational needs from basic knowledge to advanced skills. The findings can be used in designing women-specific educational programs related to HIV in Iran. Larger studies are suggested with gender-mixed samples in the Persian context.

Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 270. Comparing posterior approach lumbar and neck surgery with and without multimodal methadone

Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 270. Comparing posterior approach lumbar and neck surgery with and without multimodal methadone

Re-engineering methadone—Cost-effectiveness analysis of a patient-centered approach to methadone treatment

Methadone maintenance treatment has proven effectiveness in the treatment of opioid use disorder, but significant barriers remain to treatment retention. In a randomized clinical trial, 300 newly-admitted methadone patients were randomly assigned to patient-centered methadone (PCM) v. treatment-as-usual (TAU). In PCM, participants were treated under revised program rules which permitted voluntary attendance at counseling and other changes focused on reducing involuntary discharge, and different staff roles which shifted disciplinary responsibility from the participant's counselor to the supervisor. The study found no significant differences in treatment retention, measures of opioid use, or other patient outcomes. This paper employs an activity-based costing approach to estimate the cost and cost-effectiveness of the two study conditions. We found that service use and costs were similar between PCM and TAU. Specifically, the average cost for PCM patients was $2396 compared to $2292 for standard methadone, while the average length of stay was 2 weeks longer for PCM patients. Incremental cost-effectiveness ratios (ICER) for self-reported heroin use, opioid positive urine screens, and meeting DSM-IV criteria for opioid dependence were mixed, with TAU achieving non-significantly better outcomes at lower treatment episode costs (i.e., economically dominating) for opioid positive urine screens. PCM patients reported slightly more days abstinent from heroin and fewer meet the opioid dependence criteria. While these differences are small and not statistically significant, we can still examine the cost-effectiveness implications. For days, abstinent from heroin, the ICER was $242 for one additional day of abstinence, however, there was notable uncertainty around this estimate. For opioid dependence criteria, the ICER was $1160 for a one-percentage point increase in the probability that a participant no longer met criteria for opioid dependence at follow-up. This economic study finds that patient choice concepts can be introduced into methadone treatment without significant impacts on costs or patient outcomes.

Take Charge, Get Cured: The development and user testing of a culturally targeted mHealth decision tool on HCV treatment initiation for methadone patients

ObjectiveThis paper describes the development of a mobile health tool to facilitate Hepatitis C (HCV) treatment decision making in methadone patients. MethodsUsing an iterative, formative evaluation framework, we used commercial marketing techniques to create 3D maps of survey data to develop culturally relevant messaging that was concept tested. The resulting tool was then user tested and results were used to modify the tool. ResultsThe “Take Charge, Get Cured” tool was developed with surveys (n = 100), perceptual mapping analysis, concept testing (n = 5), and user testing (n = 10). “Think aloud” sessions were audio recorded and surveys given. Patients thought the goal of the tool was to encourage treatment and it was aimed to the needs of methadone patients. Means of 6.7–7 (on a 7 point scale) were observed for survey items related to ease of use, content, and satisfaction. ConclusionThe iterative development was essential to ensuring a culturally targeted tool, specific to the needs of HCV + methadone patients. There was a high level of acceptance for the tool. Practice ImplicationsOur study indicates that using a formative evaluation strategy is essential for development of highly targeted patient communication, especially in hard-to-reach populations.

As 42 CFR Part 2 faces possible demise, methadone patients panic, taper

Alcoholism & Drug Abuse WeeklyVolume 30, Issue 26 p. 1-4 Articles As 42 CFR Part 2 faces possible demise, methadone patients panic, taper Alison Knopf, Alison KnopfSearch for more papers by this author Alison Knopf, Alison KnopfSearch for more papers by this author First published: 01 July 2018 https://doi.org/10.1002/adaw.32018Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume30, Issue262 July 2018Pages 1-4 RelatedInformation

Switzerland Halts War on Drugs, Cuts Deaths

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