Opioid Maintenance Treatment Programme Research Articles

Investigation of the Demographic Characteristics of Patients Addicted to Opioids Undergoing Drug Maintenance Treatment in Addiction Treatment Centers in Bojnurd City

Introduction: Opium addiction is one of the most significant problems in Iran. This study investigates demographic information of opium-addicted patients undergoing maintenance treatment in Bojnurd addiction treatment centers. This study aims to identify high-risk groups and those who need therapeutic and psychosocial interventions to maintain treatments. Method: This cross-sectional study was conducted from 2016 to 2021 on 300 addicted patients referring to Bojnurd addiction treatment centers. These patients participated in the opioid maintenance treatment program for at least six months. The investigation utilized a checklist of demographic information and examined the files of addicted people undergoing maintenance treatment in eight addiction treatment centers in the city. The data were analyzed in SPSS23 software using the Chi-square statistical test. Results: The mean age (standard deviation) of the participants was 52.17±14.13 years. Besides, 76.6% of the participants were male, 70.0% resided in the city, and 73.6% were married. The majority of the participants had a primary education level and were self-employed. Opium juice was the most consumed substance, and smoking was the most common method of use. Conclusion: It appears that married and middle-aged individuals constitute the largest population undergoing maintenance treatment in Bojnurd city. The high frequency of individuals with low or no literacy in the studied population underscores the importance of education.

Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up.

High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

Depression and Suicidal Ideation among Patients Receiving Opioid Maintenance Treatments Considering Cognitive Flexibility.

Objective: Cognitive flexibility is associated with psychiatric disorders. Drug addicts experience more psychiatric disorders. This research aimed to examine depression and suicidal ideation among those receiving opioid maintenance treatment (OMT), taking into account the mediating role of cognitive flexibility. Method : This cross-sectional research was conducted on patients who were enrolled in the OMT program in Semnan in 2021 and abstained from opioid use for at least one year. 126 participants (115 males and 11 females) were randomly selected from among patients in three therapeutic groups (42 from each of the methadone, buprenorphine, and opium tincture groups). The main data collection tools were the Beck Scale for Suicide Ideation (BSSI), Cognitive Flexibility Inventory (CFI), and Beck Depression Scale (BDI-II). Data analysis was done through logistic regression models. Results: Correlation analysis between depression scores, suicidal ideation, and cognitive flexibility showed a significant correlation between each of them. Adjusting for the type of treatment, the increase in cognitive flexibility was associated with a decreasing chance of depression (odds ratio [OR] = 0.87; 95% CI [0.82, 0.92]), and the use of buprenorphine (OR = 15.1) and opium tincture (OR = 9.3), compared to methadone, were associated with a depression increase. Yet, multivariate analysis did not show an independent and significant association between cognitive flexibility and the risk of suicide. Conclusion: Based on the results, patients receiving maintenance treatments are in different conditions in terms of depression and suicide, and psychological flexibility is in correlation with depression and suicidal thinking and behavior in them. This suggests that these patients seem to benefit from cognitive training, at least in reducing their depression.

Children born to women in opioid maintenance treatment: Alongitudinal study of child behavioral problems and parenting stress.

In the wake of the "opioid epidemic", there is considerable concern regarding potential harmful long-term effects of prenatal opioid exposure. Opioid misuse and addiction confer increased exposure to lifestyle stressors and health burdens. Accordingly, it is challenging to disentangle effects of prenatal opioid exposure per se from factors related to maternal stress. In this study, we followed 36 women enrolled in comprehensive opioid maintenance treatment (OMT) program and their children alongside 36 age-matched mother-child dyads from a community sample (COMP) from pregnancy until child-age 8 years. Across five sessions, we used a battery of well-established questionnaires to investigate trajectories of parenting stress and mental health symptoms as well as child behavior problems. The 8-year retention was relatively high (OMT: 72%, COMP: 67%), and the OMT sample remarkably stable and well-functioning, with minimal concomitant illicit drug use. Mixed effects regressions showed significantly different trajectories of child behavior problems (F = 3.8, p = 0.024) and parenting stress (F = 3.1, p = 0.016) in the two groups. Differences in experienced stress were largely explained by more distress specifically related to the parenting role in the OMT group (F = 9.7, p = 0.003). The OMT sample also reported higher psychological distress (F = 15.6, p < 0.001) than the comparison group, but notably few participants presented with problems that warranted clinical intervention. The results underscore the benefits of tailored follow-up of children prenatally exposed to opioids and their families beyond infancy and toddlerhood. Long-term direct effects of prenatal opioid exposure on behavior problems are likely modest, given an otherwise stable caregiving environment conducive to healthy development.

The \u201cblack box\u201d of treatment: Patients\u2019 perspective on what works in opioid maintenance treatment for opioid dependence

BackgroundA lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients’ perspective; second, to understand which changes OMT produced in the individuals’ lives might significantly contribute to relapse prevention.MethodsWe used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting.ResultsAll the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants’ perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments.ConclusionOMT is not an isolated event in individuals’ lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.

Factors affecting the quality of life of drug dependent people under methadone maintenance treatment

Introduction: Treatment approaches for drug addiction are classified into several general types: psychosocial interventions as a part of drug-free programs, opioid maintenance treatment programs and detoxification programs. Μethadone maintenance treatment (MMT) is one of the most common therapeutic approaches. Aim: To investigate the factors that affect drug dependent people’s subjective Quality of Life (QOL) under MMT. Methods: A cross sectional study was conducted in a convenience sample of 209 drug dependent people under MMT provided by a substitution treatment unit (OKANA). They completed a questionnaire that included: a) demographic/occupational characteristics, b) the Short Form 12-Item Health Survey questionnaire (SF-12) and c) the Symptom Checklist-90-R (SCL-90-R). Data analysis was carried out using the statistical package SPSS 24.0. Results: Mean scores for the physical (PCS) and the mental (MCS) subscale of SF-12 were 47.4(±8.8) and 38.6(±9.2) respectively, displaying lower level of drug dependent people’ QOL. High mean scores of the nine symptomatic dimensions and the three global indices of the SCL-90-R demonstrate existence between addiction and psychiatric disorder. Prolonged time period over two years under MMT was associated with deterioration in their QOL. Drug dependent people with the longest stay under MMT had higher scores in the subscales of somatization (p =0.051), the obsessive-compulsive disorder (p =0.013), the Global Severity Index (p=0.041) and the Positive Symptoms Total (p=0.033). Findings indicate that female sex, the age of initiation of drugs (younger age) and previous Conclusions: In line with drug dependent people’s subjective QOL, prolonged time under MMT was associated with poor QOL. Therefore, changing MMT program’s philosophy is essential to cover drug dependent people’s further psychosocial needs.

Benzodiazepine Use in Opioid Maintenance Treatment Programme: Risks and Clinical Outcomes

The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit. We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). We conducted a descriptive, bivariable, and multivariable analysis to determine clinical differences between benzodiazepines users and non-users. The prevalence of consumption of benzodiazepines was 25.4% (60). The benzodiazepines were obtained with a medical prescription (49.8%) or on the black market (42.6%). The most prescribed benzodiazepine was diazepam (29.1%), and the main reasons were to relieve insomnia (27.7%) or anxiety (26.9%) and to enhance the psychoactive effects of other drugs (19.7%). Regarding the clinical outcomes, we highlight: a very high prevalence of hepatitis C (51.7%); severe ongoing consumption of psychoactive drugs (73.7%); and a high rate of depression and anxiety (> 60%), significantly higher in the benzodiazepines-user group. In the multivariable analysis of benzodiazepine use, we found alcohol consumption (OR 0.482; IC 95% 0.247, 0.238) had a negative association and having hepatitis C (OR 2.544, IC 95% 1.273, 5.084) or anxiety symptoms (OR 5.591; IC 95% 2.345, 13.326) had positive associations. Our results suggest the BZD users had a complex drug addiction problem and underline the importance of adequately addressing BZD use, contemplating psychological and psychiatric approach in this particular population. Past or current use of benzodiazepines is associated with poor clinical and psychiatric outcomes. A multidisciplinary approach with a focus on infectious diseases and mental health is critical in order to enhance the treatment effectiveness and overall prognosis.

Enablers and hindrances for longer-term abstinence in opioid dependent individuals receiving treatment with extended-release naltrexone: A Norwegian longitudinal recovery trial (NaltRec study)

Opioid-dependence is a comprehensive, relapsing disorder with negative individual, - family, - and societal consequences. Recovery is difficult to achieve. Research has shown reduced substance use and improved health- and psychosocial factors with extended-release naltrexone (XR-NTX) treatment. Pharmacological treatment should include psychosocial interventions to improve longer-term recovery. This study explores how voluntary monthly treatment with extended-release naltrexone hydrochloride (Vivitrol®) will influence longer-term recovery, health and psychosocial relationships in opioid-dependent patients. Close relatives’ experiences and societal costs will be assessed. This Norwegian naturalistic, multicenter, open-label study includes 150 opioiddependent patients. Patients are assessed every four weeks for 24 weeks, with 28 weeks optional follow-up treatment-period, and at three, six and 12 months posttreatment. Controls are opioid-dependent patients enrolled in Opioid Maintenance Treatment programs (n = 150). Data on recovery will be collected from participants, close relatives, and community health service providers. Genetic analyses of major signaling pathways and national registries on prescriptions and health care use will be analyzed. Recruitment period is September 2018 to September 2020. The assessment of medical, psychological, relational and societal factors may provide novel in-depth knowledge on the complexity of personal recovery-processes. The results are expected to have impact on priorities in treatment and follow-up for opioid dependent patients.

Unpredictable and Unusual Cause of Death Due to Methadone Intoxication: A New Disaster in Healthy Human Being, the Problems of Toxicology Investigation and Pathology Diagnosis: A Case Report

Objective: To demonstrate the medical morbidity risk factors of methadone intoxication in normal persons and non-opioid-user, and to show that methadone is a new disaster in Thailand. Case Report: A 35-year-old man was found dead with an unknown cause. No evidence of violence was found at the scene of death. Autopsy confirmed that death was not related to any injuries or diseases. Gross and microscopic pathologies of pulmonary and brain edema were obvious, which were caused by anoxia. No other abnormal evidence of definite pathology was found. In the present case, toxicological analyses of toxic substances and drugs were performed by liquid chromatography-mass spectrophotometry-mass spectrophotometry (LC-MS-MS) and found that the blood methadone concentration was at the lethal concentration. Therefore, the cause of death in this case was methadone toxicity. The blood concentrations of methadone and 2-ethylidene-1, 5-dimethyl-3,3-diphenylpyrrolidine (EDDP) were 1.9 µg/ml and 0.058 µg/ml, respectively. The concentration ratio of methadone and EDDP was 32.7:1, which was more than the previous death cases of methadone toxicity. The other addictive substances, such as heroin, morphine, cocaine, or ethanol, were not detected in the present case by LC-MS-MS. Conclusion: Methadone was the cause of death in this case. There was no evidence of other causes of death, especially other opiates or opioids substances. This is a big problem, because methadone is used as the substitute for heroin addiction in Thailand. The authors claim that it will be the new disaster substance and become an important cause of death in Thailand and other parts of the world, because it has been prescribed worldwide for patients undergoing a program of opioid maintenance treatment (OMT). Methadone is not controlled well. The authors demonstrated that the deceased was not in the OMT program, and the cause of death was methadone intoxication, which was a very rare case. Keywords: Methadone, Opioids, EDDP, Morphine, Ethanol, Drug substitution

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders.

Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.

The clinical consequences of variable selection in multiple regression models: a case study of the Norwegian Opioid Maintenance Treatment program

ABSTRACT Background: Selecting which variables to include in multiple regression models is a pervasive problem in medical research. Objectives: Based on questionnaire data (n = 18538, 69.9% men) from the Norwegian Opioid Maintenance Treatment Program, this study aims to compare the performance of different variable selection methods and the potential clinical consequences of choice of method. The effect of missing data is also explored. Methods: The dependent variable was engagement in criminal behavior while in treatment. Twenty-nine potential covariates on demographics, psychosocial factors and drug use were tested for inclusion in a multiple logistic regression model. Both complete case and multiply imputed data were considered. We compared the results from variable selection methods ranging from expert-based and purposeful variable selection, through stepwise methods, to more recently developed penalized regression using the Least Absolute Shrinkage and Selection Operator (LASSO). Results: The various variable selection methods resulted in regression models including from 9 to 22 covariates. The stepwise selection procedures generated the models with the most covariates included. The choice of variable selection method directly affected the estimated regression coefficients, both in effect size and statistical significance. For several variables the expert-based approach disagreed with all data-driven methods. Conclusions: The choice of variable selection method may strongly affect the resulting regression model, along with accompanying effect sizes and confidence intervals. This may affect clinical conclusions. The process should consequently be given sufficient consideration in model building. We recommend combining expert knowledge with a data-driven variable selection method to explore the models’ robustness.

Opioid maintenance treatment and Cannabis use

More than 30 % of patients participating in an opioid maintenance program consume cannabis. This article describes the effects of additional cannabis use during an opioid maintenance treatment program. Narrative literature research using online publication databases (MedLine, PubMed) RESULTS: The additional use of cannabis during an opioid maintenance treatment program may have negative side effects. Cannabis use should be discussed with the patient. It is in principle not a reason for discontinuing an opioid maintenance treatment program.

Availability of Extended-Release Naltrexone May Increase the Number of Opioid-Dependent Individuals in Treatment: Extension of a Randomized Clinical Trial

Background and objective: Opioid maintenance treatment (OMT) is highly available in Norway, but only 50% of opioid-dependent individuals are enrolled in such programs. This study was aimed at examining if availability of extended-release naltrexone (XR-NTX) could attract individuals who for different reasons were not enrolled in an OMT program. Methods: In a Norwegian clinical study, n = 117 opioid-dependent adults volunteered to receive XR-NTX in a 9-month period, as an extension of a previous randomized clinical trial. Results: Before study inclusion, 40.2% (n = 47) of the study participants were not enrolled in OMT while the remainder were recruited from OMT. Participants not enrolled in OMT displayed more ongoing severe addiction-related problems such as heroin use (p = 0.002), but displayed a higher retention in treatment in the 9-month extension study (p = 0.048 for log-rank test) than participants enrolled in OMT. Conclusion: Availability of XR-NTX attracted opioid-dependent individuals not previously enrolled in OMT. While OMT may be perceived as a burden with regard to daily intake and control measures, one-monthly injections with XR-NTX may be perceived favourable, offering more freedom to the patients, not having addictive properties, and potentially reducing heroin craving. We suggest that an introduction of XR-NTX in Europe may increase the number of opioid-dependent individuals in treatment.

Concurrent Amphetamine and Methamphetamine Use Among Clients of Opioid Maintenance Treatment Programs in Golestan, Iran

Background: Concurrent use of stimulants during opioid maintenance treatments (OMTs) negatively impacts the treatment outcomes. Objectives: The aim of this study is to evaluate the prevalence and correlation of amphetamine and methamphetamine use among OMT clients in Golestan province-Northeast of Iran. Methods: In a cross-sectional study, 750 OMT clients were recruited through a two-stage cluster sampling. Face-to-face interviews were conducted to complete the study questionnaire. Urine samples were also taken to perform rapid drug testing for morphine, amphetamine, methamphetamine, tramadol, cannabis, and benzodiazepines. Survey analysis command in STATA was used to estimate the prevalence of drug use among the target population. Results: In this study, 8.1% (95% CI: 3.6 to 12.6) of the participants had positive urine sample for amphetamine or methamphetamine. Also, 41.8% (95% CI: 34.4 to 49.1) of the clients had positive samples for morphine. The urine positivity rate of morphine was significantly higher among those who had positive urine sample for amphetamines (68.3%; 95% CI: 51.7 to 84.9 versus 39.4% 95% CI: 31.3 to 47.6). In multivariate analysis, lifetime alcohol consumption (adjusted OR: 2.8, 95% CI 1.5 to 5.5) and history of imprisonment (adjusted OR: 2.2, 95% CI: 1.0 to 4.6) were associated with positive urine sample for amphetamines. Conclusions: Simultaneous use of amphetamines among clients of OMTs was considerable. It is recommended to regularly test all OMT clients for concurrent use of stimulants. This is particularly important for clients with past history of alcohol consumption or imprisonment.

Factors associated with ongoing criminal engagement while in opioid maintenance treatment

IntroductionThis study examines factors associated with criminal engagement among patients in opioid maintenance treatment (OMT). MethodsQuestionnaire data recorded annually among 5654 patients in the Norwegian OMT programme between 2005 and 2010 from seven regional treatment centres were available for analyses. Each patient answered approximately 4 times (mean: 4.11, SD: 1.46) generating a total of 18,538 questionnaires. The outcome variable of the study, engagement in criminal activity, was defined as whether a patient had been arrested, put in custody, been charged and/or convicted of a crime within the last 12months prior to the completion of the questionnaire. Three types of covariates were included: demographical, psychosocial and drug use-related. Missing data were imputed using Multivariate Imputation by Chained Equations and regression parameters were estimated by Generalized Estimation Equations to account for correlated measurements. ResultsHaving a full-time job (aOR: 0.47, CI: 0.34–0.64) or being a student/having a part-time job (aOR: 0.72, CI: 0.59–0.88) was negatively associated with ongoing criminal involvement, as did having a stable living situation (aOR: 0.70, CI: 0.57–0.87). On the other hand, being male (aOR: 1.83, CI: 1.59–2.10), younger (aOR: 0.96, CI: 0.95–0.97) and using illicit drugs regularly (aOR: 3.00, CI: 2.56–3.52) was positively associated with ongoing criminal activity while in OMT. ConclusionsStable accommodation and participation in meaningful daily activity was found to be protective in terms of ongoing criminal engagement. Focus on these modifiable, psychosocial factors should therefore be an important and integral aspect of opioid maintenance treatment.

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Background/Aims: Increasing rates of overdose deaths involving opioid maintenance treatment (OMT) medications and particularly methadone have been observed concurrently with the implementation of liberal OMT strategies (i.e. minimum of control and high doses prescribed). This study examined methadone-related overdose deaths in a liberal OMT programme. Methods: Drug-overdose deaths (n = 130) with detection of methadone in Copenhagen, Aarhus, and Odense Municipality, Denmark, during the period 2008-2011 were identified from a registry. Cases with and without prescribed methadone as OMT were compared. Treatment delivery strategy among OMT-prescribed methadone cases was investigated. Results: Methadone was detected in 130 overdose deaths (71.4% of all overdose deaths). Among these, 63.1% were receiving methadone maintenance treatment. Of these, 79.3% had co-detection of benzodiazepines. Concomitant detection of heroin, non-prescribed benzodiazepines, and younger age were associated with having non-prescribed methadone in the toxicological findings (adjusted OR 3.1, 4.0 and 9.5, respectively). Of the decedents, 43.8% were prescribed a higher methadone dose than recommended (>120 mg daily), of which 80.0% did not have supervised intake of methadone. Conclusions: Liberal OMT access does not necessarily prevent overdose deaths overall. Prescription of higher doses of methadone combined with benzodiazepines may result in an increased risk of overdose for individuals in as well as outside OMT.

Characteristics of methadone-related fatalities in Norway

There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000–2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 – methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 – multiple additional drugs/substances detected below lethal levels (n = 175); group 3 – one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective.

BackgroundOpioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. The opioid maintenance treatment (OMT) programme represents an opportunity for people who are opioid users to minimize the many negative health and societal outcomes associated with opioid use through meeting the physiological need of their bodies for opioids. The purpose of this study is to shed some light on how clients in the Norwegian OMT programme see their level of influence on their own treatment.MethodIt is a qualitative enquiry using semi-structured interviews of seven OMT clients living in various locations in Norway. The analysis of the material utilized a grounded theory-inspired approach.ResultsThis study show that the clients who were part of the OMT programme had better lives than people with untreated addictions did. However, the participants experienced having to play by the rules of the OMT programme if they wanted to have successful treatment. This resulted in varying degrees of dissatisfaction with the treatment.ConclusionsThe results indicated that the clients felt objectified and disenfranchised in the OMT programme, and points out the low level of influence on their own treatment felt by the OMT clients.

Comparing Mindfulness-Based Group Therapy With Treatment as Usual for Opioid Dependents

Background:: In response to high burden of opioid abuse in Iran, Ministry of Health has launched a large-scale opioid maintenance treatment program, delivered through a network of certified drug treatment centers. To promote opioid pharmacotherapies, there is an urgent need to develop and introduce evidence-based psychosocial interventions into the network. Patients and Methods:: This is a randomized clinical trial (RCT) to investigate feasibility and effectiveness of adding mindfulness-based group therapy to opioid pharmacotherapies as compared to opioid pharmacotherapies alone. The primary outcomes were treatment retention and percentage of weekly morphine, methamphetamine, and benzodiazepine negative tests. Discussion:: This is the first RCT that explores the effectiveness of mindfulness-based relapse prevention group therapy among opioid dependent clients in Iran. The feasibility of group therapy and comparison of outcomes in intervention and control groups should be discussed in the outcome article.

Comparing Mindfulness-Based Group Therapy With Treatment as Usual for Opioid Dependents: A Pilot Randomized Clinical Trial Study Protocol.

Background:In response to high burden of opioid abuse in Iran, Ministry of Health has launched a large-scale opioid maintenance treatment program, delivered through a network of certified drug treatment centers. To promote opioid pharmacotherapies, there is an urgent need to develop and introduce evidence-based psychosocial interventions into the network.Patients and Methods:This is a randomized clinical trial (RCT) to investigate feasibility and effectiveness of adding mindfulness-based group therapy to opioid pharmacotherapies as compared to opioid pharmacotherapies alone. The primary outcomes were treatment retention and percentage of weekly morphine, methamphetamine, and benzodiazepine negative tests.Discussion:This is the first RCT that explores the effectiveness of mindfulness-based relapse prevention group therapy among opioid dependent clients in Iran. The feasibility of group therapy and comparison of outcomes in intervention and control groups should be discussed in the outcome article.