Methadone maintenance

About: Methadone maintenance is a research topic. Over the lifetime, 4642 publications have been published within this topic receiving 147011 citations.

Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Abstract: Methadone is widely used as a replacement for illicit opioid use such as heroin in medically-supported opioid substitution maintenance programmes. Two other drugs have been used to help reduce illicit opioid use, specifically buprenorphine and LAAM (levo-alpha-acetylmethadol). LAAM is not used in current clinical practice. Buprenorphine is currently used and can reduce illicit opioid use compared with placebo, although it is less effective than methadone. Buprenorphine is an opioid drug that is not as potent as heroin and methadone, although the effects of buprenorphine may last longer. Buprenorphine can be taken once every two days. The trials include different formulations of buprenorphine: sublingual solution, sublingual tablets, combined buprenorphine/naloxone sublingual tablet and an implant. Key results The review of trials found that buprenorphine at high doses (16 mg) can reduce illicit opioid use effectively compared with placebo, and buprenorphine at any dose studied retains people in treatment better than placebo. Buprenorphine appears to be less effective than methadone in retaining people in treatment, if prescribed in a flexible dose regimen or at a fixed and low dose (2 - 6 mg per day). Buprenorphine prescribed at fixed doses (above 7 mg per day) was not different from methadone prescribed at fixed doses (40 mg or more per day) in retaining people in treatment or in suppression of illicit opioid use.

Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence

Abstract: BACKGROUND: Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed. OBJECTIVES: To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence. SEARCH STRATEGY: We searched the following databases up to Dec 2008: the Cochrane Controlled Trials Register, EMBASE, PubMED, CINAHL, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF-VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs. SELECTION CRITERIA: All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. DATA COLLECTION AND ANALYSIS: Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta-analysis and double-entered. MAIN RESULTS: Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56-0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10-2.39). AUTHORS' CONCLUSIONS: Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.

Substance Abuse: A Comprehensive Textbook

Abstract: Part 1 Background: historical perspectives epidemiology federal role in substance abuse policy international perspectives on substance abuse policy and treatment. Part 2 Determinants and perpetuators of substance abuse: vulnerability genetics craving conditioning factors brain reward mechanisms psychodynamics sociocultural and economic aspects of drug use and abuse economics and political basis. Part 3 Substances and areas of abuse: alcohol - clinical aspects alcohol - neurobioloy opiates - clinical aspects opiates - neurobiology cocaine (and crack) - clinical aspects cocaine (and crack) - neurobiology marihuana amphetamines and other stimulants anxiolytics, sedative-hypnotics and trycyclis hallucinogens phencyclidine (PCP) volatile substances controlled substance analogues - (designer drugs) OTCs nicotine caffeine anabolic steroids. Part 4 Related compulsive and addictive behaviours: eating disorders gambling sects and cults sexual addictions. Part 5 Evaluation and early treatment: diagnosis and classification - DSM-IV-R and ICD-10 diagnostic interview and mental status examination diagnostic laboratory - screening for drug abuse emergency management of acute drug intoxication detoxification and treatment. Part 6 Treatment approached: 12 step programmes therapeutic community (TC) rehabilitation programmes and half-way houses psychiatric hospitals for treatment of dual diagnosis 12 step alternatives - secular organization for sobriety and rational recovery individual psychotherapy structured outpatient group therapy family therapy treatment in correctional settings psychopathology relapse prevention social network therapy methadone maintenance alternative pharmacotherapies for opiate addiction (LAAM, Buprenorphinr, Naltrexone) alternative medicine acupuncture religion evaluation and treatment outcome treatment matching. Part 7 Management of associated medical conditions: maternal and neonatal effects of alcohol and drugs the medically ill substance abuser treatments of patients with psychotherapy acute and chronic pain substances of use and abuse and sexual behaviour. Part 8 HIV infection and AIDS: HIV infection among intravenous drug users - epidemiology and emerging public health perspectives medical aspects of immunodeficiency virus infections and its treatment in injecting drug users neuropsychiatric complications management of the psychosocial sequelae of Hiv infection among drug users effects of narcotics on immune function. Part 9 Special populations: women children of substance abusing parents co-dependence, addictions and related disorders adolescent substance abuse substance abuse in the elderly gays, lesbians and bisexuals African Americans Hispanic Americans the homeless Native Americans, Asians, and new immigrants health professionals. Part 10 Prevention and education: school and community-based prevention public health approached (Part contents).

Psychiatric and Substance Use Comorbidity Among Treatment-Seeking Opioid Abusers

Abstract: Background: Major studies of psychiatric comorbidity in opioid abusers reported rates of comorbidity that far exceeded general population estimates. These studies were published more than a decade ago and reported on few women and few substance use diagnoses. Methods: Psychiatric and substance use comorbidity was assessed in 716 opioid abusers seeking methadone maintenance. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic assessment was conducted 1 month after admission. Rates of psychiatric and substance use disorder were compared by gender, and associations were assessed between psychiatric comorbidity and dimensional indexes of substance use severity, psychosocial impairment, and personality traits. Results: Psychiatric comorbidity was documented in 47% of the sample (47% women and 48% men). Antisocial personality disorder (25.1%) and major depression (15.8%) were the most common diagnoses. Patients had at least 2 substance use diagnoses, most often opioid and cocaine dependence. Demographics, substance use history, and personality variables discriminated between patients with vs without comorbidity. Psychiatric comorbidity also was associated with a more severe substance use disorder. Conclusions: Psychiatric comorbidity, especially personality and mood disorder, was common in men and women. The positive associations between psychiatric comorbidity and severity of substance use and other psychosocial problems were most consistent among those with antisocial personality.