Opiate Dependence Research Articles

Heroin maintenance treatment: From idea to research to practice

Maintaining opiate addicts on opiates has a long history. The idea to prescribe pharmaceutical morphine as a substitute for street heroin started in USA and was abolished on the basis of prohibitionist legislation. A new approach to maintain opiate addicts on substitution therapy was initiated in USA in 1963, with the prescription of methadone. This approach found, although slowly, increasing acceptance, and is nowadays considered to be a cornerstone in the management of opiate dependence and for the prevention of HIV/AIDS in opiate injectors. Since 1975, the concept of heroin maintenance treatment was re-activated in order to reach out to treatment-resistant heroin addicts. Research projects were performed in Switzerland, the Netherlands, Germany, Spain, Canada and in England, another one is planned in Belgium. Based on the unanimously positive outcomes, heroin maintenance has become routine treatment for otherwise untreatable heroin addicts in Switzerland, the Netherlands, Germany and England, and Denmark has set up heroin maintenance without new research trials.

Differing age related trajectories of dysfunction in several organ systems in opiate dependence

Several lines of evidence suggest that the multisystem disease seen in drug addicts may reflect acceleration of underlying degenerative or ageing processes. Patients presenting for management of their clinical opiate substance use disorder (SUD) were therefore compared with general medical non-SUD (N-SUD) patients. Differences in dental, psychiatric and hair graying indices at both temple and vertex were studied and combined with principal component (PC) analysis. Arcsinh transformation of the data were considered, as this improved the normality of the parameter distributions. 95 opiate dependent SUD and 32 N-SUD patients were studied. The mean (±SD) ages were 33.47±7.98 vs 57.81±17.13 years and sex was 75.8% and 63.6% male (p - n.s.) in the SUD and N-SUD groups respectively. The addicted population was more severe as a function of age on all indices (p<0.05). The arcsinh transformation of PC1+PC2 was significantly different by addiction status both as a category on its own and after interaction with age (both p<0.0005), and was associated with a calculated 22.3% age advancement at 60 years of age. Interactions between age, and PC's of opiate and inhaled intoxicant dose and duration of exposure were highly significant (p<0.01). Tobacco, cannabis, heroin and methadone dose and/or duration of exposure were significantly related to the identified physiological deficit both alone, and as interactions with each other and with age (most interactions p<0.01). These findings have implications for understanding the pathophysiology of drug addiction and imply that the high rate of morbidity seen in drug dependent patients may be related to underlying subclinical ager related changes, choice of opiate pharmacotherapeutic agent, considerations of duration of treatment, and conversely for the pathophysiology of the development of age related disease.

Alpha‐synuclein and heroin craving in opiate‐dependent patients on injectable heroin maintenance

Research suggests that alpha-synuclein (SNCA) and NACP-Rep1, a polymorphic complex microsatellite repeat ~10 kb upstream of the SNCA gene translational start, may be involved in substance-use behaviors and craving. This study was the first to examine the effects of diacetylmorphine (DAM) on peripheral SNCA protein expression along with craving in opiate-dependent patients and to compare their NACP-Rep1 allele lengths with those of healthy controls. Using an experimental design, opiate-dependent patients on injectable heroin maintenance were investigated at four time points, twice pre- and post-injection of DAM. SNCA protein levels of 30 DAM-maintained patients were measured using enzyme-linked immunosorbent assay. Participant-rated effects were assessed in 42 patients by Tiffany's Heroin Craving Questionnaire (HCQ), Gossop's Short Opiate Withdrawal Scale and Visual Analogs. NACP-Rep1 alleles of 42 patients and 101 controls were analyzed. One-way repeated-measures ANOVAs provided significant overall effects for SNCA protein content (P = 0.028), craving (P < 0.001), withdrawal symptomatology (P < 0.001) and mood (P < 0.001), indicating that DAM injections may not only reduce craving but also SNCA protein expression. However, there was no association between protein expression and craving. Relative to controls, patients had significantly longer NACP-Rep1 alleles (P < 0.001). NACP-Rep1 allele lengths correlated positively with HCQ total scores averaged across all time points (r = 0.420; P = 0.006) as well as with post-DAM HCQ total scores in the morning (r = 0.488, P = 0.001) and afternoon (r = 0.423, P = 0.005). The findings provide evidence of a contributory role of SNCA and NACP-Rep1 for opiate dependence.

Diverse behavioral, monoaminergic and Fos protein responses to opioids in Warsaw high-alcohol preferring and Warsaw low-alcohol preferring rats

Predisposition to addictions is presumably related to a dysfunction of the brain reward system, which can be 'compensated' by the intake of different psychoactive drugs. Hence, animals showing propensity for developing dependence to a specific drug class may also be useful for modeling other addictions. We compared the effects of repeated (14 daily doses) morphine (10 mg/kg) or methadone (2 mg/kg) treatment followed by a 2-week withdrawal and a morphine challenge (5 mg/kg) on locomotor activity, brain Fos expression and selected brain regional levels of dopamine, serotonin and their metabolites in the 38th generations of selectively bred Warsaw low-alcohol-preferring (WLP) and Warsaw high-alcohol-preferring (WHP) rat lines. The rats were given the opioids during the active (i.e. dark) phase of their daily cycle. Drug-naïve WHP rats compared to their WLP counterparts showed higher locomotor activity in an open field test and higher propensity for lasting behavioral sensitization to morphine. Morphine did not significantly enhance, but suppressed Fos expression in certain brain regions of drug-naïve WLP and WHP rats. Fos expression revealed considerable differences in the responses of WLP and WHP rats to morphine challenge, particularly after methadone pretreatment. These differences were associated with differences in monoamine metabolite levels that were suggestive of elevated basal ganglia and lowered frontal cortical dopamine function, and of lowered somatosensory cortex serotonin function, in the morphine-challenged WHP rats (irrespective of the pretreatment type). Hence, the WLP/WHP line pair may be useful for the search of factors that underlie the propensity for developing opiate dependence.

Opiyat Bağımlılarında CYP2D6 Polimorfizmi ve Adli Bilimlere Katkıları

Objective: The CYP2D6 enzyme shows a wide range of polymorphisms. It is responsible for the metabolism of substances such as opiates that have a great importance in forensic sciences. However, some mutations damage the activity of this enzyme and cause interruption in metabolism of the drugs which may lead to unexpected adverse drug reactions, even to death. Although many studies have dealt with CYP2D6 polymorphism, there is no research concerning CYP2D6 enzyme polymorphism and opiate dependence in our country. Material and Methods: We aimed to investigate the single nucleotide polymorphisms of CYP2D6*3, *4 and *6 alleles. Forty nine opiate addicts and 34 control samples were studied using tetra-primer polymerase chain reaction (PCR) technique in a single tube and by dividing the protocol into two steps. Results: CYP2D6*4 and CYP2D6*6 alleles frequencies were determined as 0.082 and 0.031, respectively, however no significant result was obtained for CYP2D6*3. Allele and genotype frequencies of CYP2D6*4 and *6 for both opiate addicts and control group were in concordance with the Hardy-Weinberg equation. Conclusion: We suggest that detection of CYP2D6 polymorphism may clarify the sudden-unexpected deaths due to intoxication of opiate addicts and some negative autopsy cases related to medical or illicit drugs.

Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder.

Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an "oddball" task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions.

α7 Nicotinic acetylcholine receptors in the central amygdaloid nucleus alter naloxone-induced withdrawal following a single exposure to morphine

Negative motivational withdrawal from acute opiate dependence was induced by an opioid antagonist, and the withdrawal signs prevented by pretreatment with nicotine. The present study was undertaken to examine the mechanism of nicotine-induced attenuation of withdrawal precipitated by naloxone in rats administered a single dose of morphine. Conditioned place aversion (CPA) was precipitated by naloxone in rats exposed once to morphine. Nicotinic acetylcholine receptor (nAChR) agonists were microinjected into the central amygdaloid nucleus (CeA) before naloxone was administered. Additionally, c-Fos expression in the amygdala was measured in rats exposed to α7 nAChR ligands. The microinjection of nicotine (0.3 and 1.0μg/μl) into the CeA dose-dependently inhibited naloxone-induced CPA. This inhibition of CPA was reversed by methyllycaconitine (MLA), an α7 nAChR antagonist. CPA was also significantly attenuated by the microinjection of tropisetron (3.0μg/μl), an α7 nAChR agonist and 5-hydroxytriptamine 3 (5-HT(3)) receptor antagonist, but not by ondansetron (1.0 and 3.0μg/μl), a 5-HT(3) receptor antagonist. The microinjection of PNU-282987 (3.0μg/μl), a selective α7 nAChR agonist, into the CeA also inhibited CPA. Furthermore, nicotine increased c-Fos expression in the CeA, but not the medial or basolateral amygdaloid nucleus. The increase of c-Fos in the CeA was significantly inhibited by MLA. Nicotine-induced attenuation of CPA precipitated by naloxone is mediated by the α7 nAChR subtype, and the CeA is one of the regions of the brain involved in the effect of nicotine on acutely opiate-dependent subjects.

Ibogaine therapy in the treatment of opiate dependency

Ibogaine therapy offers a viable alternative to mainstream treatment for opiate addiction. The combination of the addiction‐arresting and fast‐acting properties of ibogaine, with the slow and thoughtful conversation of psychoanalytical psychotherapy is a novel approach to what still remains a difficult condition to overcome.Safer than methadone, ibogaine use is steadily increasing world‐wide, and is becoming a more accepted treatment for opiate addiction. This year it has become a prescription medication in New Zealand. Howard Lotsof, who discovered the anti‐addictive properties of ibogaine 47 years ago, and who died in January 2010, devoted his life to improving access to ibogaine treatment, and instigated the first ibogaine providers' conference in Mexico in 2009.This paper explores the use of ibogaine and psychoanalytic psychotherapy in the clinic for the treatment of opiate dependency, the relationships between the two approaches, and how they differ from other treatment modalities.

'Over the counter' (OTC) opiate abuse treatment.

Over the counter (OTC) medication abuse is an increasing public health concern. We studied the clinical profiles, treatment and prevalence of patients admitted with OTC opiate abuse. Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded. Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.0 mg per person. Some 75% percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have co-morbid psychiatric (n=19, 95%), physical (n=17,85%) and polysubstance (n=13,65%) illness. OTC opiate abuse is a significant problem which is largely covert in nature with serious co-morbidity and frequent complications including withdrawal symptoms which require treatment. Results of this study suggest that further research is warranted in this area.

Participation of L-type voltage-gated calcium channels in facilitation of long-term potentiation during the formation of morphine dependence in rats

Parameters of long-term potentiation in the system mossy fibers-CA3 pyramidal neurons in hippocampal slices in experimental animals vary during the formation of chronic opiate dependence. During the first day of morphine treatment, the value of potentiation was significantly lower than in controls. Starting from day 8 and at early stages of dependence (days 25-29), facilitation of long-term potentiation was recorded. Incubation of the slices with L-type Ca(2+)-channel blocker nifedipine did not change the response to the test stimuli and did not affect potentiation induction in hippocampal slices from control and morphine-treated animals. Nifedipine had no effect on long-term potentiation of mossy fibers in the control and at early terms of morphine treatment, but significantly reduced its facilitation at later terms.

Drug Treatment as HIV Prevention: A Research Update

Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.

Drug–drug interactions in the treatment of HIV infection: focus on pharmacokinetic enhancement through CYP3A inhibition

The aim of this review is to discuss the effect of pharmacokinetic drug-drug interactions (DDIs) in the antiretroviral treatment of HIV infection. In particular, but not exclusively, DDIs due to the cytochrome P450 3A (CYP3A) inhibitor ritonavir, which is used to increase antiretroviral drug exposure - a technique known as pharmacokinetic enhancement or 'ritonavir boosting'- will be reviewed. The emphasis here will be on the treatment of important co-morbidities common in patients with HIV, including dyslipidaemia, hypertension, tuberculosis and opiate dependence, as well as on the potentially life-threatening interaction between ritonavir and inhalational steroids, and on the effect of acid-reducing agents on some antiretroviral drugs. Finally, further developments with regard to the use of CYP3A-blocking agents to augment the efficacy of antiviral therapy will be discussed.

Opiate treatment for opiate withdrawal in newborn infants

Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. To assess the effectiveness and safety of using an opiate compared to a sedative or non-pharmacological treatment for treatment of NAS due to withdrawal from opiates. The review was updated in 2010 with additional searches CENTRAL, MEDLINE and EMBASE supplemented by searches of conference abstracts and citation lists of published articles. Randomized or quasi-randomized controlled trials of opiate treatment in infants with NAS born to mothers with opiate dependence. Each author assessed study quality and extracted data independently. Nine studies enrolling 645 infants met inclusion criteria. There were substantial methodological concerns in all studies comparing an opiate with a sedative. Two small studies comparing different opiates were of good methodology.Opiate (morphine) versus supportive care (one study): A reduction in time to regain birth weight and duration of supportive care and a significant increase in hospital stay was noted.Opiate versus phenobarbitone (four studies): Meta-analysis found no significant difference in treatment failure. One study reported opiate treatment resulted in a significant reduction in treatment failure in infants of mothers using only opiates. One study reported a significant reduction in days treatment and admission to the nursery for infants receiving morphine. One study reported a reduction in seizures, of borderline statistical significance, with the use of opiate.Opiate versus diazepam (two studies): Meta-analysis found a significant reduction in treatment failure with the use of opiate.Different opiates (six studies): there is insufficient data to determine safety or efficacy of any specific opiate compared to another opiate. Opiates compared to supportive care may reduce time to regain birth weight and duration of supportive care but increase duration of hospital stay. When compared to phenobarbitone, opiates may reduce the incidence of seizures but there is no evidence of effect on treatment failure. One study reported a reduction in duration of treatment and nursery admission for infants on morphine. Compared to diazepam, opiates reduce the incidence of treatment failure. A post-hoc analysis generates the hypothesis that initial opiate treatment may be restricted to infants of mothers who used opiates only. In view of the methodologic limitations of the included studies the conclusions of this review should be treated with caution.

Sedatives for opiate withdrawal in newborn infants

Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. Treatments used to ameliorate symptoms and reduce morbidity include opiates, sedatives and non-pharmacological treatments. To assess the effectiveness and safety of using a sedative compared to a non-opiate control for NAS due to withdrawal from opiates, and to determine which type of sedative is most effective and safe. This update included searches of the Cochrane Central Register of Controlled Trials (Issue 1, 2010), MEDLINE 1966 to April 2010 and abstracts of conference proceedings. Trials enrolling infants with NAS born to mothers with an opiate dependence with > 80% follow-up and using random or quasi-random allocation to sedative or control. Control could include another sedative or non-pharmacological treatment. Each author assessed study quality and extracted data independently. Seven studies enrolling 385 patients were included. There were substantial methodological concerns for most studies including the use of quasi-random allocation methods and sizeable, largely unexplained differences in reported numbers allocated to each group.One study reported phenobarbitone compared to supportive care alone did not reduce treatment failure or time to regain birthweight, but resulted in a significant reduction in duration of supportive care (MD -162.1 min/day, 95% CI -249.2, -75.1). Comparing phenobarbitone to diazepam, meta-analysis of two studies found phenobarbitone resulted in a significant reduction in treatment failure (typical RR 0.39, 95% CI 0.24, 0.62). Comparing phenobarbitone with chlorpromazine, one study reported no significant difference in treatment failure.In infants treated with an opiate, one study reported addition of clonidine resulted in no significant difference in treatment failure, seizures or mortality. In infants treated with an opiate, one study reported addition of phenobarbitone significantly reduced the proportion of time infants had a high abstinence severity score, duration of hospitalisation and maximal daily dose of opiate. Infants with NAS due to opiate withdrawal should receive initial treatment with an opiate. Where a sedative is used, phenobarbitone should be used in preference to diazepam. In infants treated with an opiate, the addition of phenobarbitone or clonidine may reduce withdrawal severity. Further studies are needed to determine the role of sedatives in infants with NAS due to opiate withdrawal and the safety and efficacy of adding phenobarbitone or clonidine in infants treated with an opiate for NAS.

Hypothalamic opioid–Melanocortin appetitive balance and addictive craving

Whilst the parallels between drug and food craving are receiving increasing attention, the recently elucidated complex physiology of the hypothalamic appetite regulatory centres has been largely overlooked in the efforts to understand drug craving which is one of the most refractory and problematic aspects of drug and behavioural addictions. Important conceptual gains could be made by researchers from both appetite and addiction neuroscience if they were to have an improved understanding of each others' disciplines. It is well known in addiction medicine that the use of many substances is elevated in opiate dependency. There is voluminous evidence of very high rates of drug use in opiate agonist maintained patients, and the real possibility exists that opiate agonist therapy therefore increases drug craving. Conversely, opiate antagonist therapy with naloxone or naltrexone has been shown to reduce most chemical and behavioural addictions, and naltrexone is now being developed together with bupropion as the anti-obesity drug "Contrave". Hypothalamic melanocortins, particularly α-MSH, are known to constitute the main brake to consumptive behaviour of food. There is a well described antagonism between melanocortins and opioids at many loci including the hypothalamus. Administration of exogenous opiates is known to both suppress α-MSH and to stimulate hedonic food consumption. Opiate maintenance programs are associated with weight gain. As monoamines, opioids and cannabinoids are known to be involved in appetite regulation, and as endorphin opioids are known to be perturbed in other addictions, further exploration of the hypothalamic appetite regulatory centre would appear to be an obvious, albeit presently largely overlooked, locus in which to study drug and other craving mechanisms.

Effect of Ultra-Rapid Opiate Detoxification on Withdrawal Syndrome

ABSTRACT The aim of study was determine the effect of ultra-rapid opiate detoxification (UROD) on the presence or absence of withdrawal syndrome in a group of patients with opiate dependency. In this study, withdrawal syndrome of 173 patients with opiate addiction was evaluated before and after UROD using the Objective Opioid Withdrawal Scale. Hence, each patient was observed for 5 minutes before UROD and at different hours afterward to observe any withdrawal sign. The most prevalent withdrawal sign before UROD was anxiety. Restlessness was the most prevalent finding at 1, 3, and 6 hours. After 12 hours, yawning was reported as the most prevalent finding in 39 participants. Anxiety was reported as the most prevalent finding in 61 participants after 24 hours. Patients with opioid dependency who underwent UROD showed the highest rate of withdrawal symptoms at one hour after anesthesia. Most of these symptoms subsided after 24 hours. UROD can be applied for detoxification of patients with opioid dependency with safety.

Allosteric modulation of the NMDA receptor by neurosteroids in rat brain and the impact of long term morphine administration

This study examined the allosteric modulation of the NMDA receptor by nanomolar concentrations of neurosteroids in rats treated long term with morphine. The neurosteroids dehydroepiandrosterone sulfate (DHEAS), pregnenolone sulfate (PS) and pregnanolone sulfate (3α5βS) are important mediators in the central nervous system. They induce rapid responses by non-classical steroidal mechanisms, e.g. via interaction with the N-methyl- d-aspartate (NMDA) receptor, and are known to modify the binding of ifenprodil to the NMDA receptor subunit NR2B. The NMDA receptor is involved in several processes, including memory, learning, synaptic plasticity and neuronal development. Morphine, a μ-opioid receptor agonist, has an important role in the clinical treatment of pain. The main drawback of morphine treatment is the associated development of dependence and tolerance. The mechanisms behind these phenomena are still to be elucidated, but several reports suggest the involvement of the NMDA receptor. The results of the present study indicate that the allosteric modulation induced by the neurosteroids DHEAS, PS and 3α5βS was similar in all tested brain regions. This suggests that the NR2B receptor subunit behaves independently of its site of expression. Moreover, the NR2B subunit was up-regulated in the frontal cortex but not in the hippocampus or hypothalamus. It is concluded that morphine does not affect the neurosteroid modulatory effect on ifenprodil binding in the rat hippocampus or hypothalamus but does significantly affect both the expression of the NR2B subunit and the 3α5βS modulatory effect on ifenprodil binding in the frontal cortex. It is suggested that the observed effect of long term morphine on the properties of NR2B in the frontal cortex may be associated with the mechanism underlying the development of opiate dependence.

Examining Differences in Substance Use among Rural and Urban Pregnant Women

Substance use during pregnancy is a major public health concern. This study examined differences in substance use among pregnant women from rural and urban areas. Participants were 114 pregnant women entering a hospital-based inpatient detoxification unit primarily for Opiate Dependence who voluntarily agreed to a face-to-face interview. Substance use measures were based on the Addiction Severity Index gathering information about lifetime, past 12 months, and 30 days prior to admission. Rural pregnant women had higher rates of illicit opiate use, illicit sedative/benzodiazepine use, and injection drug use (IDU) in the 30 days prior to admission. Additionally, a greater proportion of rural pregnant women reported the use of multiple illegal/illicit substances in the 30 days prior to entering detoxification. More specifically, pregnant women from rural areas were 8.4 times more likely to report illicit opiate use, 5.9 times more likely to report IDU, 3.3 times more likely to report illicit sedative/benzodiazepine use, and 2.8 times more likely to report the use of multiple illegal/illicit substances in the 30 days prior to entering inpatient detoxification, after adjustment for socio-demographic characteristics (including education and income), pregnancy characteristics, physical and mental health indicators, and criminal justice system involvement. The increased rates of prescription opiate and benzodiazepine use as well as IDU among rural pregnant women are concerning. In order to begin to understand the elevated rates of substance abuse among rural pregnant women, substance use must be considered within the context of demographic, geographic, social, and economic conditions of the region.

Supporting clients on methadone maintenance treatment: a systematic review of nurse's role

This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.

Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment

PurposeThis study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals’ QoL.MethodsParticipants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis.ResultsFive years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one’s living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL.ConclusionsOpiate-dependent individuals’ QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.