Preference for Sweet Foods and Higher Body Mass Index in Patients Being Treated in Long-Term Methadone Maintenance

Opiate use has been associated with preference for sweets in both humans and animals. In 2002, the food preferences and eating habits of non-institutionalized patients in methadone treatment and controls were measured and compared. Questionnaires were administered to 14 patients and 14 controls with similar demographic characteristics (there were 19 women and 9 men ranging in age from 19 to 59 years). The patients reported higher consumption of sweets, higher eagerness to consume sweet foods, and a wish to consume quantities larger than that desired by controls. Patients had a significantly higher body mass than controls. The study's limitations are noted. These findings suggest a link between methadone and a desire for calorically dense foods. A study of eating behavior is warranted.     

上海地区妊娠糖尿病饮食危险因素分析

目的调查妊娠糖尿病（GDM）患者和正常孕妇的饮食行为和习惯,研究上海地区GDM患者的饮食相关危险因素。方法选择上海交通大学附属第一人民医院确诊GDM的孕妇180例作为GDM组,同期就诊非GDM孕妇180例作为对照组,对妊娠期间的饮食习惯进行问卷调查。对两组资料进行单因素和多因素条件Logistic回归分析,研究GDM相关的饮食危险因素。结果单因素Logistic回归分析结果显示,甜食、豆浆、豆制品、动物食品、荤汤、水果和坚果等饮食习惯与GDM发生间的相关性具有统计学意义（P〈0.05）。多因素Logistic回归分析显示,甜食、豆浆、肉制品、水果和坚果等饮食习惯与GDM的发生具有相关性。结论饮食习惯和GDM的发生有一定关联。喜好甜食、动物性食品及坚果是上海地区GDM饮食危险因素;豆浆是饮食保护因素;水果在每日摄入400 g以下时是饮食保护因素,超过400 g是饮食危险因素。     

Risk factors for weight gain during methadone maintenance treatment

ABSTRACT

Background: Weight gain was reported during methadone maintenance treatment (MMT). However, its relation to eating habits and specific risk factors, including methadone dose or serum level, was limited. The aims of this study were to characterize risk factors for weight gain and to study current eating habits, food preferences, and nutrition knowledge. Methods: Patients with available measures of weight and height (body mass index [BMI]) at admission to MMT and at follow-up, when methadone serum levels were determined (after 1 year or when stabilized) (N = 114), were studied (using the Addiction Severity Index [ASI], drugs in urine, methadone doses, and serum levels). In addition, 109 current patients with available earlier (5.8 ± 2.6 years earlier) BMI completed eating behavior rating and nutrition knowledge questionnaires, and their current and earlier BMI were compared. Results: The BMI of 114 newly admitted patients increased from 22.5 ± 3.8 to 24.4 ± 4.3 (P < .0005). Once stabilized on methadone, BMI increased further (24.3 ± 4.5 to 25.6 ± 5.0; P < .0005; n = 74), with no change in methadone doses (125.6 ± 32.5 to 128.0 ± 34.1; F = 1.4, P = .2) or serum levels (495.6 ± 263.7 to 539.8 ± 306.2; F = 1.3, P = .2). Repeated-measures analyses revealed that BMI elevation was higher among 45 hepatitis C virus seronegative and 46 non–benzodiazepine-abusing on-admission patients. Those who scored lower on knowledge about healthy diet and showed a higher sweet-foods preference had a higher BMI. Conclusion: BMI increased over time, but independent of methadone dosage and blood levels. As expected, worse diet habits and a desire for sweet foods are related to higher BMI. Paradoxically, healthier status (i.e., hepatitis C seronegative, no benzodiazepine abuse) at admission is predictive of greater weight gain during MMT. Education about nutrition habits is recommended.     

儿童龋病发病的相关因素研究

目的 研究儿童龋病发病的相关因素.方法 选择2013年1月至2015年6月在医院体检的儿童880例,880例儿童中760例出现龋病,龋病发病率为86.36％,患龋病患儿为研究组,未患龋病儿童为对照组,调查儿童的饮食习惯、个人卫生习惯以及家长的基本情况.结果 研究组儿童睡前进食,每日进食新鲜水果次数≤1次,每周喝碳酸饮料≥2次、每天吃甜食≥2次比例大于对照组,差异均有统计学意义(均P＜ 0.05);研究组儿童自主刷牙、每日刷牙≤1次、刷牙开始年龄≥3岁比例大于对照组,差异均有统计学意义(均P＜ 0.05);研究组父母从事商业服务工作比例显著高于对照组,差异有统计学意义(P＜0.05);Logistic回归分析结果显示,睡前进食、每日进食水果次数≤1次、每日吃甜食≥2次、每周喝碳酸饮料≥2次、儿童自主刷牙、每日刷牙≤1次、刷牙开始年龄≥3岁、父母从事商业服务工作均是儿童龋病的发病因素.结论 个人卫生、饮食习惯均是直接影响龋病发生的因素,父母应该多关注孩子的身心健康,培养儿童较好的口腔卫生习惯和饮食习惯.     

影响深圳社区单纯性儿童肥胖的家庭行为因素研究

目的研究儿童单纯性肥胖的影响因素,为预防儿童肥胖的发生提供依据。方法选取按身高标准体重法判定的3~6岁单纯性肥胖儿童80例作为病例组,在他们的邻居按照配对原则与正常儿童进行1∶2配对选出160例为对照组。进行体格测量及问卷调查,采用卡方检验比较两组儿童家庭行为状况。结果正常儿童父母对肥胖的认识程度比肥胖组儿童父母对肥胖的认识程度高（P〈0.01）;肥胖组儿童父母以零食作为奖励的比率高于正常组儿童的父母（P〈0.01）;肥胖组儿童的父母比正常组更爱好甜食或油炸食品（P〈0.01）;正常组儿童的运动量明显高于肥胖组儿童（P〈0.01）。结论预防儿童单纯性肥胖症不单要健康饮食,还要对家长进行健康教育,帮助他们建立正确的健康观。     

Electrocardiogram characteristics of methadone and buprenorphine maintained subjects

There has been recent concern about the association between high dose methadone and prolongation of QTc in the electrocardiogram. QTc is the time from the beginning of the QRS complex to the end of the T have as measured on an electrocardiogram and corrected for heart rate. To date, no association has been made between methadone and buprenorphine in commonly used doses and prolonged QTc. Electrocardiograms were performed on groups of methadone (n = 35, mean daily dose +/- standard deviation, 69 +/- 29 mg) and buprenorphine (n = 19, mean daily dose 11 +/- 5 mg) subjects and a group of non-opioid dependent controls (n = 17). Mean QTc did not differ (p = 0.45) between methadone, buprenorphine, or controls. Methadone subjects were significantly (odds ratio of 7.8) more likely to have U waves than buprenorphine and controls combined. Methadone subjects with U waves were maintained on higher (p = 0.004) doses (89 +/- 29 mg/day) than methadone subjects without U waves (60 +/- 24 mg/day). Methadone subjects taking 60 mg and above had higher (p = 0.02) QTc (405 +/- 29 milliseconds) than methadone subjects taking less than 60 mg per day (381 +/- 27 milliseconds). Although an association is thought to exist between high methadone doses and elongated QTc, methadone and buprenorphine, at commonly used daily doses, remain safe agents for opioid substitution therapy.     

Electrocardiogram Characteristics of Methadone and Buprenorphine Maintained Subjects

ABSTRACT

There has been recent concern about the association between high dose methadone and prolongation of QTc in the electrocardiogram. QTc is the time from the beginning of the QRS complex to the end of the T have as measured on an electrocardiogram and corrected for heart rate. To date, no association has been made between methadone and buprenorphine in commonly used doses and prolonged QTc. Electrocardiograms were performed on groups of methadone (n = 35, mean daily dose ± standard deviation, 69 ± 29 mg) and buprenorphine (n = 19, mean daily dose 11 ± 5 mg) subjects and a group of non-opioid dependent controls (n = 17). Mean QTc did not differ (p = 0.45) between methadone, buprenorphine, or controls. Methadone subjects were significantly (odds ratio of 7.8) more likely to have U waves than buprenorphine and controls combined. Methadone subjects with U waves were maintained on higher (p = 0.004) doses (89 ± 29 mg/day) than methadone subjects without U waves (60 ± 24 mg/day). Methadone subjects taking 60 mg and above had higher (p = 0.02) QTc (405 ± 29 milliseconds) than methadone subjects taking less than 60 mg per day (381 ± 27 milliseconds). Although an association is thought to exist between high methadone doses and elongated QTc, methadone and buprenorphine, at commonly used daily doses, remain safe agents for opioid substitution therapy.     

Correlates of methadone client retention: a prospective cohort study in Guizhou province, China

BackgroundMethadone client retention levels and treatment doses of patients vary widely in methadone clinics across China. Because methadone clinics have been available in China only recently, this study explored the relationship between methadone dosage and client retention in methadone maintenance programmes in Guizhou province.MethodsThe study used a prospective cohort study design. Injecting and non-injecting heroin-using clients who had been treated for no more than two and half months in one of eight methadone maintenance treatment clinics in Guizhou province were recruited into the cohort, beginning on 3 June 2006 and followed up until 1 June 2007. A total of 1003 participants were enrolled. Face-to-face interviews were conducted to collect baseline information, and clients’ daily doses were recorded.ResultsThe 14-month retention rate was 56.2%. Controlling for other covariates in the multivariate Cox model, a higher methadone dose was found to predict higher client retention. Retention was also associated with intention to remain in treatment for life and the clinic attended.ConclusionClients need to receive an adequate methadone dose to assure continued retention. Patients who expect to be treated for life have higher retention rates than patients who anticipate only short-term treatment. Key factors associated with successful clinics in China need to be elucidated.     

A pilot study of the nutritional status of opiate-using pregnant women on methadone maintenance therapy

Pregnant women in methadone maintenance therapy may have poor nutrition during pregnancy. In 2006-2008, methadone-treated pregnant women (n = 22) were recruited at an urban academic medical center and compared with nondrug-using pregnant women (n = 119) at 20-35 weeks' gestation. We measured adiposity using prepregnancy body mass index (BMI), dietary intake using a food frequency questionnaire, and micronutrient and essential fatty acid status using biomarkers. Methadone-treated women had lower BMI, consumed more calories, had lower serum carotenoid concentrations, and higher plasma homocysteine concentrations than controls. The study's limitations and implications for future research are discussed.     

老年代谢综合征患者的生活行为方式研究

目的 调查老年代谢综合征(MS)患者的生活行为方式,分析其特征及意义.方法 对318例老年人群进行全面调查后,分为MS组63例、一项代谢异常组135例、二项代谢异常组51例及对照组67例进行分析,评估各危险因素对MS的影响.结果 (1)MS组的腰围(WL)显著高于其余3组(P<0.05),体质指数(BMI)与对照组...     

Leaving methadone maintenance treatment: the role of personality traits and psychiatric status

This study investigates personality traits and psychiatric status among 174 methadone patients (121 men and 53 women) and 387 untreated controls (191 men and 196 women) in Sweden in 1993 and 1994. The methadone patients were followed up to 1998 with respect to being expelled from treatment. Pretreatment factors, like home background and behavioral factors, were studied in relation to treatment outcome. The methadone patients were interviewed using a structured questionnaire about alcohol and drug use and psychological, social, and behavioral factors. To obtain data about personality traits, the patients were asked to fill in a questionnaire, the Karolinska Scales of Personality (KSP) questionnaire. The male methadone patients had significantly (p < 0.0001) higher scores on somatic anxiety, muscular tension, impulsiveness, and psychasthenia, and significantly lower scores with regard to socialization, social desirability, and inhibited aggression compared with the controls. Compared with the female controls, the female methadone patients differed most significantly (p < 0.0001) in respect of socialization. Low socialization, social desirability, detachment, feelings of guilt, and suspicion were most predictive for later expulsion from treatment. Nearly half of the methadone patients who suffered from human immunodeficiency virus (HIV) infection had difficulties with compliance with the treatment and were later expelled. The results suggest that awareness of personality traits and psychiatric status may be crucial for a better methadone treatment outcome.     

Aggressive responding of male heroin addicts under methadone treatment: psychometric and neuroendocrine correlates.

Objective measures of experimentally-induced aggressiveness were evaluated in 20 methadone-treated heroin addicts, in comparison to 20 normal healthy male subjects. All the subjects were submitted to preliminary DSM IV interviews, Buss Durkee Hostility Inventory (BDHI) and Minnesota Multiphasic Personality Inventory (MMPI II). During a laboratory task, the point subtraction aggression paradigm (PSAP), subjects earned monetary reinforcers with repeated button presses, and were provoked by the subtraction of money, which was attributed to a fictitious other participants. Subjects could respond by ostensibly subtracting money from the fictitious subject (the aggressive response), or protecting their counter (escape response). Money-earning responses were significantly lower (t=4.38, P<0.001) and aggressive responses significantly higher (t=5.45; P<0.001) in methadone patients in comparison to controls. During the experimentally-induced aggressiveness, plasma adrenocorticotropic hormone (ACTH), cortisol (CORT) and growth hormone (GH) concentrations increased significantly less and norepinephrine (NE) and epinephrine (EPI) levels, together with heart rate (HR), significantly more in methadone subjects than in healthy subjects. PSAP aggressive responses positively correlated with catecholamines changes, BDHI 'direct' and 'irritability' scores, MMPI 'psychopathic deviate' scores both in methadone subjects and controls, and with CORT responses only in healthy subjects. No correlation was found between methadone doses, or exposure extent, and aggressiveness levels. Our findings suggest that heroin dependent patients have higher outward-directed aggressiveness than healthy subjects, in relationship with monoamines hyper-reactivity, also under methadone medication. Aggressiveness in methadone patients seems to be related more to the personality traits than to drug effects. Hypothalamus-pituitary-adrenal (HPA) axis responses, unexpectedly dissociated from catecholamines rise among methadone patients, could be due to a long-lasting inhibitory action exerted by opiates on pro-opio-melanocortin (POMC), or to a premorbid psychobiological condition that exhausted hormonal reactivity.     

The relationship between mood state and plasma methadone concentration in maintenance patients

Although methadone maintenance is designed to stabilize opioid-dependent patients, some experience significant withdrawal in the latter part of the 24-hour interdosing interval. This study was designed to determine the mood changes that maybe associated with such withdrawal. Eighteen methadone patients, nine of whom experienced significant withdrawal, were tested over a single interdosing interval. During this time, 13 blood samples were collected to measure plasma racemic methadone concentrations, and the Profile of Mood States (POMS) was administered on 11 of these occasions. The POMS was also administered on 11 occasions over 24 hours to 10 drug-free healthy controls. In comparison with controls, methadone patients showed increased anger, depression, tension, confusion, and fatigue, as well as decreased vigor. For all scales, maximal differences from controls occurred at times of trough methadone concentration and minimal differences around the time of peak concentration. Changes in mood over the interdosing interval were more exaggerated in the nine patients who experienced significant withdrawal compared with those who did not. The composite Total Mood Disturbance (TMD) scores were calculated for each subject at each time point. The sigmoid Emax model was used to relate plasma concentrations to these data and to calculate the slope factor (N). This model could be fitted for 14 of the 18 patients with a mean +/- SEM slope factor of 2.2 +/- 0.5. TMD score was also shown to be inversely related to the rate of decline in methadone concentration from peak to trough. These results show that significant mood changes occur in response to changes in methadone concentration, and these are more pronounced in those who experience withdrawal. The concentration-effect relationships suggest that relatively small changes in plasma concentration will result in significant mood change. Differences in the degree of mood change between those who do and do not experience significant withdrawal may be explained by variation in the rate of decline in plasma concentration from peak to trough.     

Metabolic determinants of binge eating

Binge-eating behavior is often thought to be the consequence of energy restriction and dietary restraint. However, evidence is accumulating that recurrent eating binges may be one behavioral mechanism in the expression of familial obesity, and may therefore precede the onset of dieting. The profile of patients with the DSM-IV binge-eating disorder resembles that of patients with familial obesity. There is further evidence for the involvement of the endogenous opiate peptide system. Binge-type foods are often rich in fat, sugar, or both. The opiate antagonist naloxone reduced the consumption of sweet high-fat foods in obese and lean female binge-eaters, though not in nonbinging controls. In contrast, obese as opposed to lean subjects were not differentially affected by naloxone. These data provide a psychobiological validation of the DSM-IV binge eating disorder and suggest that binge eating may be triggered by physiological events. As opposed to being the outcome of dieting, binge-eating episodes should be considered as its possible cause.     

Delay discounting, impulsiveness, and addiction severity in opioid-dependent patients

Individuals who abuse drugs show higher delay discounting (DD) rate and impulsiveness scores compared with controls; however, it is unclear if DD rate covaries with severity of the addiction or if an individual's discounting rate can be changed by effective substance abuse treatment. This study compared methadone maintenance treatment (MMT) patients (n = 30) who had not used illegal drugs for 2 years with drug-using MMT patients (n = 30) and controls (n = 25) in terms of addiction severity, DD rate, and impulsiveness. Methadone patients abstinent from illegal drugs scored significantly lower on a number of addiction severity measures than the drug-using methadone patients. In addition, both groups of MMT patients showed significantly higher rates of DD and impulsiveness than the control group; however, no differences in DD rate or impulsiveness were found between the groups of patients. Results suggest that DD rate and impulsiveness may not covary with indicators of addiction severity in MMT patients.     

Serum concentrations of opioids when comparing two switching strategies to methadone for cancer pain

Purpose

Our aim was to compare pharmacological aspects of two switching strategies from morphine/oxycodone to methadone; the stop and go (SAG) strategy in which methadone is started directly after the initial opioid has been stopped, and the 3-days switch (3DS), in which morphine/oxycodone is gradually changed to methadone by cross-tapering over 3 days.

Methods

Forty-two cancer patients with pain and/or opioid side effects were assessed in this randomised trial. Trough serum concentrations of methadone, morphine, morphine-6-glucuronide (M6G), and oxycodone were measured on days 1, 2, 3, 4, 7, and 14. Primary outcome was number of patients with methadone concentrations in apparent C_SS on day 4. Secondary outcomes were exposure to opioids during the first 3 days, interindividual variation of opioid concentrations, and correlation between methadone concentrations and pain intensity (PI) day 3.

Results

Thirty-five patients received methadone (16 in the SAG group, 19 in the 3DS group). The median preswitch morphine equivalent doses were 620 (range 350–2000) mg/day in the SAG group and 800 (range 90–3600) mg/day in the 3DS group (p?=?0.43);42% reached C_SS for methadone in the SAG group on day 4 compared with 22% in the 3DS group (p?=?0.42). The SAG group was significantly less exposed to morphine/M6G/oxycodone and significantly more exposed to methadone in the first 3 days. Methadone showed a low correlation with PI. More patients dropped out after intervention in the SAG group than in the 3DS group (38% vs. 5%; p?=?0.032). One SAG patient suffered from respiratory depression on day 5.

Conclusion

The SAG group was initially more exposed to methadone and less to the replaced opioids but without observed clinical benefit and with a higher dropout rate. Patients switched to methadone should be followed closely for the first 5 days, regardless of switching strategy.     

Neuropsychological functioning in opiate-dependent subjects receiving and following methadone maintenance treatment

OBJECTIVE: An accumulating body of research suggests that former heroin abusers in methadone maintenance therapy (MMT) exhibit deficits in cognitive function. Whether these deficits are present in former methadone maintained patients following discontinuation of MMT is unknown. This study tests the hypothesis that former heroin users who have detoxified from methadone maintenance therapy and are drug-free have less pronounced cognitive impairment than patients continuing long-term MMT. METHOD: A series of neuropsychological tests were administered to three groups of subjects: 29 former heroin addicts receiving methadone maintenance treatment, 27 former heroin addicts withdrawn from all opiates, and 29 healthy controls without a history of drug dependence. Testing included Wechsler Adult Intelligence Scale-Revised Vocabulary Test, the Stroop Color-Word Test, the Controlled Oral Word Association Test, the Benton Visual Retention Test, and a Substance Use Inventory. FINDINGS: Both methadone-maintained and abstinent subject groups performed worse than controls on tasks that measured verbal function, visual-spatial analysis and memory, and resistance to distractibility. Abstinent subjects performed worse than their methadone maintained counterparts on tests measuring visual memory and construct formation. Cognitive impairment did not correlate with any index of drug use. CONCLUSIONS: We confirmed previous findings of neuropsychological impairment in long-term MMT recipients. Both patients receiving MMT and former heroin users in prolonged abstinence exhibited a similar degree of cognitive impairment. Cognitive dysfunction in patients receiving methadone maintenance may not resolve following methadone detoxification.     

Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial

Buprenorphine has rarely been administered as an opioid agonist maintenance therapy in a correctional setting. This study introduced buprenorphine maintenance in a large urban jail, Rikers Island in New York City. Heroin-dependent men not enrolled in community methadone treatment and sentenced to 10-90 days in jail (N=116) were voluntarily randomly assigned either to buprenorphine or methadone maintenance, the latter being the standard of care for eligible inmates at Rikers. Buprenorphine and methadone maintenance completion rates in jail were equally high, but the buprenorphine group reported for their designated post-release treatment in the community significantly more often than did the methadone group (48% vs. 14%, p<.001). Consistent with this result, prior to release from Rikers, buprenorphine patients stated an intention to continue treatment after release more often than did methadone patients (93% vs. 44%, p<.001). Buprenorphine patients were also less likely than methadone patients to withdraw voluntarily from medication while in jail (3% vs. 16%, p<.05). There were no post-release differences between the buprenorphine and methadone groups in self-reported relapse to illicit opioid use, self-reported re-arrests, self-reported severity of crime or re-incarceration in jail. After initiating opioid agonist treatment in jail, continuing buprenorphine maintenance in the community appears to be more acceptable to offenders than continuing methadone maintenance.     

High-dose methadone maintenance in rats: effects on cocaine self-administration and behavioral side effects.

It has been demonstrated that high-dose methadone maintenance is efficacious in reducing cocaine abuse in opioid-dependent individuals, but it is not clear whether this is caused by an action of methadone on the direct reinforcing properties of cocaine or on cocaine seeking. Also, it is not clear whether high-dose methadone maintenance may induce behavioral side effects, which could limit its clinical use. Here, we report that high-dose methadone maintenance (20-40 mg/kg/day) does not reduce, and even enhances cocaine (10-30 mg/kg, i.p.)-induced elevation in dopamine concentration in the ventral striatum measured by in vivo microdialysis. In parallel, however, rats maintained on high-dose methadone (30 mg/kg/day) seek and consume significantly less cocaine than controls when tested for intravenous cocaine (0.5 mg/kg/infusion) self-administration on a progressive ratio schedule of reinforcement. This reduction in cocaine self-administration does not result from impaired sensory-motor functioning as rats maintained on high-dose methadone show normal locomotor activity. Furthermore, the reduction in responding for cocaine does not seem to result from general behavioral deficits as male rats maintained on high methadone doses respond normally to palatable food and thermal pain, although their sexual responses to receptive females are greatly suppressed. Taken together, these results from studies in rats support the usefulness of larger doses of methadone to reduce severe cocaine abuse in opioid-dependent individuals and possibly in the management of pure-cocaine addiction.     

The psychobiology of comfort eating: implications for neuropharmacological interventions

Comfort eating, that is eating induced by negative affect, has been a core theme of explanations for overeating and obesity. Psychobiological explanations and processes underlying comfort eating are examined, as well as its prevalence in clinical and nonclinical populations, to consider who may be susceptible, whether certain foods are comforting, and what the implications for treatment may be. Comfort eating may occur in a substantial minority, particularly in women and the obese. Human and animal theories and models of emotional or stress-induced eating show some convergence, and may incorporate genetic predispositions such as impulsivity and reward sensitivity, associated with dopamine dysregulation underlying incentive salience. Comfort eaters show vulnerability to depression, emotional dysregulation and a need to escape negative affect and rumination. During negative affect, they preferentially consume sweet, fatty, energy-dense food, which may confer protection against stress, evidenced by suppression of the hypothalamic-pituitary-adrenal axis response, although activation of the hypothalamic-pituitary-adrenal axis may itself drive appetite for these palatable foods, and the risk of weight gain is increased. Benefits to mood may be transient, but perhaps sufficient to encourage repeated attempts to prolong mood improvement or distract from negative rumination. Cognitive behavioural treatments may be useful, but reliable drug therapy awaits further pharmacogenomic developments.