Diazepam use among methadone maintenance patients: Patterns and dosages

Methadone maintenance patients who use benzodiazepine drugs were interviewed about the dosage levels, patterns, frequency and motives for their use of these drugs. The sample was drawn from two treatment clinics, one in Baltimore (N = 12) and one in Philadelphia (N = 17). Benzodiazepine use was prevalent at both of these clinics — 65–70% of maintenance patients had positive urinalysis tests during a single month. Ninety-three per cent of survey participants identified diazepam as the drug which they used most often. The median value of the usual daily dose was 40–45 mg, 31% reported usual daily doses between 70 and 300 mg and 62% had experience with doses of 100 mg and higher. The majority of the sample reported taking diazepam in a single daily dose within one hour of the time that they ingested their daily methadone; 72% of the sample indicated that diazepam boosts the effects obtained from the daily methadone dose. Another sample of addicts who reported extensive experience with both benzodiazepines and barbiturates indicated that diazepam increases the effects of methadone while barbiturates produce no change in the effects of methadone. Results of this study suggest that patterns and dosages of diazepam use among methadone maintenance patients are primarily abusive rather than therapeutic.     

Patterns of service use and treatment involvement of methadone maintenance patients

Although methadone maintenance is an effective treatment for opiate addiction, variations in treatment outcome are evident. These variations may be explained in part by the rehabilitative experiences of patients as reflected in their use of collateral services. This study examined service involvement of 409 methadone maintenance patients at four clinics in order to identify the types of services used and the extent to which potentially rehabilitative services were used. Aside from welfare, there was a strikingly low level of service utilization. Even when services were used, the levels of this use were so low as to be virtually ineffective. These findings regarding treatment and social service utilization suggest that there may not be any attempt to match service provision with patient needs for services. A more rational approach to matching patient needs and available services is thus called for.     

Social relationships and intravenous drug use among methadone maintenance patients

This study examined the extent to which social relationships were associated with continued injection drug use and needle sharing among 252 methadone maintenance patients. Logistic regression analyses indicated that drug use was highest among persons who had a substance using live-in partner and among those with more drug-using social relationships. Among injectors, whites and those who had more people present during IV drug use were more likely to share needles, while those with more emotional support were less likely to do so. These findings suggest that personal relationships strongly influence continued injection drug use and that methadone programs should help patients develop social networks of non-users.     

Treatment process components and heroin use outcome among methadone patients

The study proposes and tests an integrative and directional (structural equations) model to explain how pre-treatment motivation, frequency and content of counselling services, programme perceptions, and methadone dose are related to 1 and 6 months heroin use outcomes among opiate addicts receiving outpatient methadone treatment. Data were collected as part of the National Treatment Outcome Research Study (NTORS). The sample comprised 262 patients who were admitted to, and retained in methadone treatment programmes at 6 months. Structural equation models showed several relationships between treatment process variables and heroin use outcomes at 1 and 6 months follow-up. Programme perceptions and methadone dose were related to reduced heroin use at 1 month; early engagement with treatment services was related to reduced heroin use at 6 months. Pre-treatment motivation and engagement with treatment services were indirectly related to reduced heroin use at 1 month through their association with programme perceptions. Short-term (1 month) heroin use was strongly related to heroin outcome at 6 months. In addition to direct effects, treatment factors may have important indirect effects upon subsequent outcomes through their influence upon short-term outcomes.     

美沙酮维持治疗受治者偷吸情况及其影响因素分析

目的：了解美沙酮维持治疗受治者毒品偷吸情况及影响因素,为进一步采取有效措施提高治疗效果提供依据。方法：对治疗时间20d以上的知情同意的受治者进行横断面问卷调查和尿液吗啡定性检测,并结合门诊记录信息进行分析.结果：毒品偷吸率54．2％（96／177）。Logistic回归分析结果显示无固定工作、接受治疗时间短、吸毒时间长和有注射吸毒史等是影响偷吸的可能因素。结论：受治者在治疗期间偷吸毒品是较常见的现象,应加强思想教育和心理辅导、增加激励机制和社会帮教等提高维持时间,减少偷吸率。     

Alcohol use problem among patients in methadone maintenance treatment in Taiwan

Aims

To examine the prevalence rate and predictors of alcohol use problems among patients undergoing methadone maintenance treatment (MMT).

Design

This was a prospective follow-up study.

Participants

Study population included 438 patients who underwent more than 6 months of MMT.

Measurements

Demographic and clinical characteristics were collected for each patient prior to treatment, and treatment-related variables were collected during treatment process. Hazardous drinking, alcohol abuse, and dependence were measured using a Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by measuring breath alcohol concentration.

Findings

The prevalence rates of alcohol use problems, indicated by hazardous drinking are 31.4%. The protective predictors of alcohol use problems among MMT patients include an attendance rate of more than 90% (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.30–0.97) and being older than 36 years (OR = 0.48, 95% CI = 0.27–0.86), and alcohol drinking problem at intake of study is a risk factor (OR = 5.30, 95% CI = 2.87–9.76).

Conclusions

High attendance rate, which is regarded as a component of clinical policy and a key component of therapeutic context, should be incorporated with brief interventions to lower alcohol use problems among MMT patients.     

Clobazam maintenance among methadone maintenance patients with problematic benzodiazepine use: five case studies

The aim of this pilot study was to determine the potential of maintenance with clobazamin patients on methadone who were also benzodiazepine dependent. Five individuals were recruited and four were maintained on clobazam for a minimum of 3 months prior to reduction. Three subjects were abstinent from other benzodiazepines at 3 months. Clobazam was given as a single daily dose and was reported by the clients as less sedating than diazepam. There is potential for clobazam to be used as a maintenance benzodiazepine. [Wickes WA, Darke S, Ross J. Clobazam maintenance among methadone maintenance patients with problematic benzodiazepine use: five case studies. Drug Alcohol Rev 2000;19:401-405]     

Supplementary methadone self administration among methadone maintenance clients.

The present study derives from two related questions: (1) Can methadone dose alterations act as reinforcers? (2) Do methadone dose alterations affect symptomatology of methadone maintained clients? Twenty three clients were offered six opportunities to alter their own methadone dose on a single day by as much as ±20 mg. Dose increases were selected on the vast majority of occasions (94.3%). Thus, supplemental methadone did function as a reinforcer for these clients. There was little evidence that dose increases which clients chose had any appreciable subjective effects. Neither symptomatology self reports nor judgements of dosage adequacy were significantly altered following acute methadone dose increases.The amount of supplemental methadone which clients self-administered could not be predicted by demographic characteristics, by length of time enrolled in maintenance treatment, by type or amount of illicit supplementary drug use, or by adequacy judgements of stable methadone dose. However, dosage self-regulation may have predictive potential as a measure of degree of behavioral dependence on narcotic drugs.     

Concurrent heroin use among methadone maintenance clients in China

Background

The study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients' demographic characteristics, treatment experience, and personal social network.

Methods

Face-to-face surveys were conducted with 178 clients randomly recruited from six methadone maintenance treatment (MMT) clinics in Sichuan, China. Concurrent heroin use was measured based on self-report of heroin use during the past 30 days and a confirmatory urine morphine test. The participants' demographic characteristics and treatment factors were measured and examined. The drug use status of their family members and friends was also assessed.

Results

A total of 80 participants (44.9%) who either reported illicit heroin use in the past 30 days or had a positive urine test were defined as using heroin concurrently. Having drug-using friends was significantly associated with increased concurrent heroin use. Longer length of treatment (2 years or longer) was associated with increased concurrent heroin use. Among those who had both drug-using family members and friends, more women (71.4%) than men (50.0%) used heroin. For those who had no drug-using family members or friends, more men (34.8%) than women (20.8%) used heroin.

Discussion

Study findings indicate an urgent need to address concurrent illicit heroin use among MMT clients. Further examination of the influence of social networks on concurrent drug abuse behavior is encouraged. Results also highlight the importance of understanding gender differences in treatment seeking and behavioral changes, which is crucial to the development of gender-specific treatment strategies.     

Relationship between problem gambling and substance use in a methadone maintenance population

Few studies have examined the relationship between pathological gambling and substance abuse treatment outcome. This study assessed the gambling behavior of 62 patients enrolled in a methadone maintenance treatment program. Eleven (17.7%) met current SOGS criteria for probable pathological gambling. Patients with and without probable pathological gambling were compared on substance abuse treatment outcome measures including urine toxicology results for heroin and cocaine use, and clinic dropout. Results indicated that those who were probable pathological gamblers were more likely to use cocaine through therapy, and more likely to drop out of the clinic treatment program than nonpathological gamblers. Implications for substance abuse treatment are discussed.     

Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan,China

Introduction and Aims. Multiple substance use leads to greater levels of psycho‐behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. Design and Methods. A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. Results. All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co‐use). The most common combination of co‐use pattern was heroin with depressant. Common reasons for co‐use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co‐use were education, marital status and family relationship. Discussion and Conclusions. Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.[Li L, Sangthong R, Chongsuvivatwong V, McNeil E, Li J. Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, China. Drug Alcohol Rev 2010]     

Drug use and HIV risk-taking behaviour among clients in methadone maintenance treatment.

Current drug use and HIV risk-taking behaviour of a sample of 95 methadone maintenance clients was investigated. Subjects had been on their current programme for an average of 70.9 weeks with a mean daily dose of methadone of 65.6 mg. Two-thirds had injected heroin, and 82% had injected a street drug in the month prior to interview. Over 20% of subjects had shared a needle in the month before interview, all with only one other person. Subjects who had injected cocaine in the month before interview had significantly higher levels of injecting risk-taking behaviour than those subjects who had injected but not used cocaine. Condom use among subjects was low, particularly in regular relationships. While knowledge concerning HIV was high among subjects, there was no relation between level of knowledge and actual behaviour. It is concluded that knowledge alone is not sufficient to ensure behaviour change.     

Patterns of drug use and expectations in methadone patients

Expectations about future behavior have been shown to have a positive relationship with subsequent behavior. For patients in drug treatment, recovery should manifest changes in drug use and in cognitive perceptions of being able to refrain from use. The present study identified latent patterns of the longitudinal relationship between drug use expectation and illegal drug use during treatment. Latent variable mixture modeling identified three patterns of change over successive 3-month intervals during treatment: Improvers (48%), Decliners (33%), and Continuing Users (19%). The sample consisted of 497 patients in community-based outpatient methadone treatment. The utility of the latent patterns was shown through their relationship to treatment engagement, where Continuing Users had lower counseling rapport and time in treatment. These latent patterns also differed on drug use measures at follow-up. Additional analyses of expectations with measures of opioid use, cocaine use, or criminality yielded similar latent patterns. Expectations about future drug use were found to be a useful measure of cognitive change corresponding to drug use change. Its potential as a brief treatment management tool is noted.     

Post-traumatic stress disorder among inner city methadone maintenance patients

There has been little attention to the problem of violent stressors leading to post-traumatic stress disorder (PTSD) among opioid-dependent patients. In a sample of methadone maintenance patients, the prevalence of lifetime PTSD was determined to be 20% for women and 11% for men. The most common stressors reported were rape for women and seeing someone hurt or killed for men. Further research with methadone patients focused on PTSD should also ascertain current rates of PTSD and determine whether special treatments for PTSD and related problems of depression and suicidal ideation are necessary.     

Parental relationships and substance use among methadone patients: The impact on levels of psychological symptomatology

The relationship between parental substance use problems (SUPs) and the quality of parental relationships with levels of psychological symptomatology was examined in 155 female and 324 male methadone maintenance patients. Subjects completed the Beck Depression Inventory (BDI), SCL-90, and the Treatment Effectiveness Questionnaire (TEQ), which included questions regarding demographics, drug use, family/social relationships, and substance use in relatives. Of those completing the questionnaire, 40% were randomly selected for an Addiction Severity Index (ASI) interview. As hypothesized, parental SUPs were associated with greater levels of psychological symptomatology, more family/social, and medical problems. Positive parental relationships were associated with significantly lower levels of psychological symptomatology and fewer family/social problems. Males were significantly more likely than females to report positive parental relationships and no parental SUPs. No differences based on race were revealed related to reports of the quality parental relationships or parental SUPs.     

Controlled use of heroin in patients on methadone maintenance treatment

The efficacy of methadone maintenance treatment was evaluated on 93 patients after 10 years of therapy. On the basis of therapeutic compliance, patients were divided into three groups: (a) 40 Total-Agreement subjects on weekly take-home methadone; (b) 28 Partial-Agreement subjects, who regularly attended the clinic daily but presented episodic positive urinalysis; (c) 25 No- Agreement patients, who were absent from the clinic more than twice a monthand had a high rate of urinalysis positive for morphine. Statistical analysis, based on social adjustment improvement and criminality rate decrease, divided the 93 patients into 2 distinct categories. The first category, characterized by high social adjustment and low criminality score, included the Total- and Partial- agreement groups. The second, characterized by significantly lower social adjustment and higher criminality score, included all No-Agreement patients. This suggests that methadone treatment was able to dissociate heroin use from low social functioning. It was concluded that, in a condition of adequate compliance the episodic use of heroin is of no harm to patients on methadone maintenance therapy, that is, methadone maintenance treatment permits a controlled use of heroin.     

Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study

This was a 6-month, randomized, flexible-dose study comparing the effects of methadone (Meth) and buprenorphine (Bup) on retention rate and substance use in a sample of 140 opioid-dependent, primarily heroin-addicted, patients who had been without opioid substitution therapy in the 4 weeks prior to the study. The major aims were to compare the efficacy of Bup and Meth in a flexible dosing regimen and to identify possible predictors of outcome. There were no major inhomogeneities between treatment groups. All patients also received standardized psychosocial interventions. Mean daily dosages after the induction phase were 44-50 mg for Meth and 9-12 mg for Bup. Results from this study indicate a favourable outcome, with an overall retention rate of 52.1% and no significant differences between treatment groups (55.3% vs. 48.4%). Substance use decreased significantly over time in both groups and was non-significantly lower in the Bup group. Predictors of outcome were length of continuous opioid use and age at onset of opioid use, although these were only significant in the Bup group. Mean dosage and other parameters were not significant predictors of outcome. Overall, the results of this study give further evidence that substitution treatment is a safe and effective treatment for drug dependence. Meth and Bup are equally effective. Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome. The intensity of withdrawal symptoms showed the strongest correlation with drop-out. Future studies are warranted to further address patient profiles and outcome under different substitution regimens.