State-Trait Anxiety in Methadone Maintenance Patients

Changes in A-State and A-Trait in methadone maintenance patients have been assessed. It was found that following the administration of the daily dosage of methadone, A-State was significantly reduced but no changes in A-Trait occurred. The measurements were obtained during a 6-month period.     

A Placebo-Controlled Trial of Dextromethorphan as an Adjunct in Opioid-Dependent Patients Undergoing Methadone Maintenance Treatment

Background:

Low-dose dextromethorphan (DM) might have anti-inflammatory and neurotrophic effects mechanistically remote from an NMDA receptor. In a randomized, double-blind, controlled 12 week study, we investigated whether add-on dextromethorphan reduced cytokine levels and benefitted opioid-dependent patients undergoing methadone maintenance therapy (MMT).

Methods:

Patients were randomly assigned to a group: DM60 (60mg/day dextromethorphan; n = 65), DM120 (120mg/day dextromethorphan; n = 65), or placebo (n = 66). Primary outcomes were the methadone dose required, plasma morphine level, and retention in treatment. Plasma tumor necrosis factor (TNF)-α, C-reactive protein, interleukin (IL)-6, IL-8, transforming growth factor–β1, and brain-derived neurotrophic factor (BDNF) levels were examined during weeks 0, 1, 4, 8, and 12. Multiple linear regressions with generalized estimating equation methods were used to examine the therapeutic effect.

Results:

After 12 weeks, the DM60 group had significantly longer treatment retention and lower plasma morphine levels than did the placebo group. Plasma TNF-α was significantly decreased in the DM60 group compared to the placebo group. However, changes in plasma cytokine levels, BDNF levels, and the methadone dose required in the three groups were not significantly different.

Conclusions:

We provide evidence—decreased concomitant heroin use—of low-dose add-on DM’s efficacy for treating opioid-dependent patients undergoing MMT.     

Methadone Maintenance: 235 Consecutive Patients

I treat heroin addiction with methadone in, I believe, the smallest community in the United States with a clinic. It has operated continuously since 1969. I have treated 235 patients; follow-up is 82%. All patients are reported; 64 are abstinent, 48 are on methadone maintenance, so 112 of 235 have achieved some measure of control.     

Double-Blind Detoxification of Methadone Maintenance Patients

Twenty-four methadone maintenance patients were assigned to (1) decreasing dose (N = 12) or (2) continued methadone maintenance (N = 12), matching for dose, initial complaint levels, and counselor. After 14 weeks most patients in both groups had terminated from the study. Detoxifying patients usually terminated by obtaining a dose increase or dropping out; maintenance patients usually terminated for external reasons. Prior to terminating, detoxifying patients reported increased withdrawal complaints but no awareness doses had decreased. Termination was not directly related to dose level or percentage decrease. In both groups, terminators were likely to have been high in complaints during the baseline period     

Counseling as an Intervention for the Cocaine-Abusing Methadone Maintenance Patient

Abstract

Using archival data from Bay Area Addiction Research and Treatment (BAART), a methadone treatment provider, this study examined the efficacy of the clinical intervention of counseling on cocaine use by BAART patients. California State Assembly Bill 2071 mandated that patients at methadone clinics be required to undergo a minimum of 50 minutes of counseling per month. Records of 179 patients continuously active in treatment beginning 12 months prior to (i.e., the baseline) and two years after AB 2071's implementation were reviewed. These patients were also identified as cocaine abusers. A pretest-intervention-posttest design was employed, with the increased counseling mandated by AB 2071 as the intervention. Cocaine abusers' urinalysis results during the one-year baseline were compared to the time period following AB 2071's implementation. The independent variable was the amount of counseling received and the dependent variable was cocaine use. The prediction was that cocaine-abusing methadone maintenance patients would have fewer cocaine positive urine analyses following AB 2071's implementation than in the 12-month baseline period preceding AB 2071. Results supported the main hypothesis that cocaine-abusing patients would show better improvement following AB 2071. Additionally, the actual amount of time in counseling was shown to lead to greater improvement in treatment for cocaine abusers. An important secondary finding was that heroin use was also negatively correlated to time in counseling. There were no gender differences in the response to the counseling treatment.     

Some Self-Esteem Correlates of Methadone Maintenance Patients

The correlates of self-esteem (SE) for 85 methadone maintenance patients were examined in this study. Number of years of education was positively related to SE. Length of time in the treatment program was also related to SE, though this relationship was not linear. Specifically, those patients who had been in treatment for 13–24 months had the highest SE, while the SE of the 25–36 month group was lowest. The implications of the data are discussed, including the possibility that they may be used to identify those patients who are likely to be successful or unsuccessful candidates for detoxification from methadone maintenance treatment programs.     

美沙酮长期维持治疗患者情况分析

目的通过对美沙酮维持治疗中坚持服药3年及以上服药人员情况进行分析,了解其一般情况及治疗情况。方法选取广州市荔湾区药物维持治疗点坚持服药3年及以上的46例服药人员作为研究对象,采用描述性统计方法对其人口学特征及治疗前后情况进行分析。结果长期维持治疗患者以男性为主,平均年龄(39.93±8.10)岁;大部分具有初中及以上文化程度;与家人、亲属或朋友居住,并有较好的家庭关系;93.48%的服药人员为无业或待业;97.80%的长期维持治疗人员吸毒时间10年以上,平均时间为(17.78±3.75)年;吸毒花费以100～500元者居多;82.6%的服药人员至治疗点所需时间在30min以下;大多数患者服药剂量为20～80mL;服药参与率中位数91.72%,尿检参与率中位数91.72%,尿检阳性率中位数14.12%。结论在治疗中对美沙酮维持治疗患者一般情况和治疗前后情况进行监测,并针对监测结果对患者采取相应干预措施有利于其长期维持,进而改善治疗效果。     

Onsite QTc Interval Screening for Patients in Methadone Maintenance Treatment

ABSTRACT

To improve the electrocardiogram screening process and early detection of patients at high risk for cardiac arrhythmias, the authors created a model in their clinic where they provided an onsite electrocardiogram screening that might be feasible and practical. The authors then performed a retrospective chart review to access the efficacy and feasibility of their new onsite procedure in identifying methadone maintained patients at high risk for cardiac arrhythmias. Records from all patients who are currently or had previously been maintained on methadone in the methadone maintenance program at the Atlanta VA Medical Center between 2002 and 2009 were evaluated. Of the 140 patients treated at the clinic between 2002 and 2009, 85 were excluded from the study because they had been treated as guests (had been in treatment in other clinics but received methadone dosing temporarily from our clinic), were treated in the clinic for less than 6 months, or dropped out of treatment. Thus, 55 patient charts were selected for review. Most patients (95%) received baseline and annual electrocardiogram screening. The average baseline QTc was (417 ± 30) and most recent QTc (442 ± 25). This QTc prolongation from baseline showed statistical significance (P < .0001). Sixty-seven percent of patients had statistically significant QTc prolongation from baseline but was less than 450 ms (mean: 428 ± 16, P = .008). Twenty-seven percent of patients had statistically significant QTc prolongation from baseline of more 450 ms but was less than 500 ms (mean: 460 ± 8, P < .0001). Six percent of patients had statistically significant QTc prolongation from baseline of more 500 ms (mean: 503 ± 1.15, P = .027). Recent cocaine use was the only individual variable that showed statistically significant correlation with QTc prolongation (F = 6.98, P = .01). The authors demonstrated in this study that providing an onsite electrocardiogram screening with a focus on patient education and limiting the referral to specialty care for patients at high risk for cardiac arrhythmias could be practical and feasible.     

Knowledge About Hepatitis-C Among Methadone Maintenance Treatment Patients in Israel

Ignorance about Hepatitis-C (HCV) among drug users, treatment staff, and policy makers thwarts treatment uptake and facilitates virus transmission. We assessed knowledge about HCV among methadone patients in Israel, where effective HCV-treatment is provided at low-cost within the national health insurance framework, yet few infected methadone patients are treated. In 2006, 512 patients in two methadone clinics in Israel were interviewed, of whom 53%% were HCV-positive. The clinics were purposively selected from the 11 methadone clinics in the country. Respondents exhibited poor knowledge about HCV, particularly about diagnosis and treatment. Lesser-educated respondents were three times more likely to score low on HCV-knowledge compared to those with 12++ years of schooling (AOR == 2.97, 95%% CI == 1.5–5.7. HCV-negative patients were also three-times more likely than HCV-positive patients to score low on the HCV-knowledge scale (Adjusted Odds Ratio == 3.0, 95%% Confidence Interval == 1.9–4.7). Enhancing HCV-knowledge may help patients avoid becoming infected and infecting others, allay exaggerated fears about hepatitis, and facilitate HCV-treatment initiation among those infected.     

Methadone Maintenance Treatment

This paper reviews the world literature on methadone. Methadone has been used in hundreds of thousands of patients, in disparate social, economic, cultural, and geographic situations; it has been evaluated in scores of studies. The large majority of evaluations demonstrate that opioid use, criminality, and general health status are affected positively in many addicts. Smaller gains in job and family functions are noted. Alcoholism and multiple drug use complicate treatment for some addicts. Despite the positive data, public opinion remains negative about this treatment. The use of methadone in withdrawal from opioid dependence and in pregnancy complicated by opioid dependence is discussed.     

Methadone Maintenance:

Since first developed by Dole and Nyswander, there have been significant changes in the clinical use of methadone, based on evaluation of the initial programs and a better understanding of the psychology and pharmacology of addictive behavior. Treatment has evolved from Dole's original concept that methadone "blockaded" the euphoric effect of heroin to current usage which reflects a greater appreciation of methadone's ability to prevent the development of withdrawl symptoms and to moderate intense affective states. The successes and limitations of methadone maintenance are best appreciated in comparison with alternative treatment modalities including therapeutic communities and detoxification. Program administrators face unique pressures because of the need to resolve the often contradictory goals of patients, staff, community groups, law enforcement officials, government regulators and funding agents. The evolution of effective treatment models has been greatly impaired by these pressures. Clinicians must become more effective leaders in helping to resolve these problems and to help formulate more rational drug abuse treatment policy.     

Physicians' Attitudes and Retention of Patients in Their Methadone Maintenance Programs

A study was undertaken to investigate the influence of methadone prescribes' commitment to abstinence-oriented policies on retention in their maintenance programs. Two hundred and eighty patients recently enrolled in single-person, private methadone programs were interviewed and followed for 8 years. The prescribing physicians' scores on an Abstinence Orientation Scale, derived from an independent sample of methadone program staff, were significantly associated with their patients' risk of premature discharge. The influence of program orientation on retention was greater the higher the maximum dose of methadone. More attention should be paid to the effect of staff attitudes and beliefs on the effectiveness of maintenance treatment.     

Characteristics and Outcome of Minority Group Patients in Methadone Maintenance Treatment

Minority status is associated with mental and physical morbidity, substance dependence, and poor outcomes. To compare characteristics and treatment outcomes between patients from two minority groups in Israel (Christians and Muslims) and patients from the majority population (Jews) in methadone maintenance treatment (MMT), we prospectively studied all patients admitted to our clinic between 1993 and 2012 and followed up until 2013; 655 Jews, 67 Christians, and 37 Muslims. Christian patients differed from Jews and Muslims by younger age at admission to MMT, greater prevalence of drug injectors, and a higher proportion of Hepatitis-C and HIV sera positive. Muslims had comparatively less education and a lower proportion of females. The three groups had similar rates of one-year retention (75.9%) and opiate abstinence (68.1%). They also did not differ in long-term retention (up to 20 years): Muslims 5.5 years (95%CI 3.6-7.4), Christians 7.5 years (95%CI 6-9.1), and Jews 7.6 years (95%CI 7-8.2, p = .3). The Hepatitis-C incidence, however, was higher among the 21 admitted Hepatitis-C seronegative minorities (5.0/100 person years) than the 207 Hepatitis-C seronegative non-minority patients (1.7/100 person years, p=0.03). All groups had good treatment outcomes, except for Hepatitis-C seroconversion, which necessitates a specific preventive intervention among the minority groups.     

A New Work Placement Model for Unemployed Methadone Maintenance Patients

Traditionally, methadone-maintained patients have made only limited progress in vocational rehabilitation programs, largely because they encounter multiple individual-level barriers to their employment. The Customized Employment Supports (CES) model is designed to help patients overcome these employment barriers and attain paid work as soon as possible. To facilitate this transition, the model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients in a working alliance and enhance patients’ self-efficacy. Methods used to help patients increase their self-efficacy are derived from social psychological literature and include role modeling, persuasion, and minimizing emotional arousal. Because the transition to competitive work is a major change, many patients initially take smaller steps such as entering training programs and accepting informal employment. The CES model is being evaluated in a randomized clinical trial.     

Psychological Adjustment-Mood and Personality Fluctuations of Long-Term Methadone Maintenance Patients

Ethnosemantic analysis, a research method developed by structural anthropologists and linguists for studying “alien” cognitive domains, would be a useful tool for therapists who treat the alcoholic patient. In this paper a method is developed that would enable a therapist to focus upon aspects of the alcoholic patient's cognitions that are operative in the patient's drinking behavior. Three sorts of objectively derived information are obtained: (1) a list of cognitive factors that threaten the patient's self-concept, (2) a taxonomic sorting of these factors, and (3) a measure of the differential stressfulness of these factors to the patient. All three of these information outputs are semantically produced by the patients themselves.     

Cocaine Abuse Sharply Reduced in an Effective Methadone Maintenance Program

Abstract

A comprehensive study of an urban methadone clinic with supervised urine analyses for illicit drugs was conducted over an 18 month period for a 133 patient cohort as they entered or remained in methadone maintenance for narcotic addiction. Overall retention during the study was 85%, with significantly (p < .05) higher daily methadone doses (mean 67.1 mg ± 2.1) in those patients still in treatment at the end of the study. Predictably, illicit opioid use was dramatically reduced, to 10% as measured by urine toxicology in the last month of treatment. Moreover, significantly more patients stopped regular cocaine abuse (69%) than started using cocaine (10%, Fisher's exact test, p = .02). Thus, with effective methadone maintenance using adequate dosages, the majority of patients remain in treatment and reduce cocaine abuse as well as illicit opioid use, with implications for public health by reducing the spread of infectious diseases including hepatitis B, C, D and human immunodeficiency virus (HIV-1).     

Retention of Patients in the New York City Methadone Maintenance Treatment Program

The retention, termination, and readmission of patients admitted to the New York City Methadone Maintenance Program from November 1970 through the end of 1973 were analyzed. Sixty-seven percent of patients remained in continuous treatment for 1 year and 50% for 2 years. The retention of patients admitted in successive years declined. Women had somewhat higher retention than men, as did patients over age 30 compared with those 30 or under; there were no differences among ethnic groups. Termination rates were determined for specific reasons for termination from the program as a function of length of time in treatment and also for calendar trimesters. A sharp increase in the rate of voluntary terminations was noted during the second and third trimesters of 1973. Rates of readmission to the program were obtained, specific for reason for first termination and length of time in initial treatment. One out of five terminated patients was readmitted to the program within 24 months.     

Pathological Gambling and Obsessive Compulsive Disorder Among Methadone Maintenance Treatment Patients

ABSTRACT

The aims of this study was to assess the prevalence of lifetime pathological gambling (pathological gambling) and current obsessive compulsive disorder among former heroin addicts currently in methadone maintenance treatment. A cross-sectional study of 154 patients from a methadone maintenance treatment clinic affiliated of a tertiary-referral medical center was conducted. The South Oaks Gambling Screen and Yale-Brown Obsessive Compulsive Scale were used for measurement purposes. Lifetime pathological gambling was found in 45 (29.2%) patients (current pathological gambling was found in 10 [6.5%] patients). Clinical obsessive compulsive disorder (defined if scored as moderate to extreme) was found in 51.1% of patients in the pathological gambling groups and 39.4% of patients in the non-pathological gambling group, with higher obsessive scores in the pathological gambling group versus the non-pathological gambling group. Logistic regression (multivariate analyses) found pathological gambling in more males (odds ratio = 3.6, 95% confidence interval = 1.5–8.8), a high obsessive score (odds ratio = 1.07, 95% confidence interval = 0.1–1.1), and older age on admission (40 years and older) (odds ratio = 2.4, 95% confidence interval = 1.1–5.0). Because only 10 (6.5%) patients were still currently gambling, more urgent intervention should be considered to the unexpected high rate of clinical obsessive-compulsive disorder (42.9%) in the sample, possibly because the clinic studied is of a higher severity than that accepted to the methadone maintenance treatment clinics in the community.