A’- -Methadone

Bleich A, Gelkopf M, Weizman T, et al Benzodiazepine abuse in a methadone maintenance treatment clinic in Israel characteristics and a pharmacotherapeutic approach. Isr J Psychiatry Relat Sci 39 104-112, 2002 Bohn LM, Gainetdinov RR, Lin FT, et al Mu-opioid receptor desensitization by beta-arrestin-2 determines morphine tolerance but not dependence. Nature 408 720— 723, 2000... 

Phenytoin Similar to phenobarbital may need to increase methadone dose when phenytoin is added to a methadone maintenance drug regimen to avoid withdrawal symptoms. 

FIGURE 1.32 Extraction-time profiles for promethazine (A), methadone (B), amphetamine (C), pethidine (D), and haloperidol (E) in 1 mL sample volume with 0, 5, and 50% methanol added to plasma sample.155 (Reproduced with permission from the Royal Society of Chemistry.)... 

The methadone taper can also be conducted as an outpatient. In this case, the taper is done very slowly over a period of several months. Adjuvant medications such as acetaminophen are usually not needed for this slow detoxification. This outpatient taper is often best managed by a methadone clinic, the same clinic that provides methadone maintenance treatment. 

Parents on a methadone prescription would also face some stress in the morning as getting to the pharmacy for the daily dose of methadone would be constrained by opening times and, in the meantime, children still had to be attended to. 

This was also true of some of the social workers. The appearance of the children was taken as an important marker, particularly focused on the state of their clothes, as was the straightforward interpretation of the vignette, made by a number of individuals across the practitioner groups, that having been on a methadone prescription for the past year equated with stability. An example of this is cited below, as is the more questioning response of another social worker in the focus group ... 

A methadone detoxification is more often completed if it is done as an inpatient than as an outpatient (Gossop et al. 1986), but many individuals are reluctant to be admitted, and various other limitations of inpatient treatment were indicated in the Introduction. In attempting to provide the most useful combination of treatments in a community setting, we have no problem with offering methadone detoxification as an option, basically in cases where there are not the features favourable for the quicker methods. However, we do not expect it to proceed in a simple manner, and some of the more important practical management considerations are discussed below. 

In addition to its use as a primary detoxification agent, lofexidine is used by some clinicians as an adjunctive treatment in a methadone detoxification, to help reduce the ongoing symptoms as reduction occurs. This is not the recommended usage, and a controlled study found guanfacine ineffective in this regard (San et al. 1994). 

Another complication which can be expected in a methadone detoxification, seemingly more even than in other methods, is that of mood disturbances. In a comparison of methadone and buprenorphine withdrawal courses, actually in addition to carbamazepine, Seifert et al. (2005) found more tiredness, sensitivity in mood and depression in the (randomly assigned) methadone patients, which situation can lead to either tranquillizers or antidepressants being considered. 

If the difficulties encountered in a methadone detoxification are largely due to inability to tolerate the withdrawal features, the problems often start somewhere between one-half and three-quarters of the way through a planned reduction course. Problems much before this... 

Tremeau F, Darreye A, Leroy B, Renckly V, Ertle S, Weibel H, Khidichian F Macher JP (2003). Personality changes in opioid-dependent subjects in a methadone maintenance treatment program. L Encephale, 29, 285-92... 

Prior to commencing a methadone programme, the drug user has completed an assessment battery. This used to assess changes over several areas of functioning. It included ... 

Analgesic efficacy and clinical use Levomethadyl acetate, a methadone derivative, is a long-acting opioid analgesic, which is mostly used for the treatment of opioid dependence (Blaine etal., 1978 Ling, 1978)... 

An interesting example of yield and selectivity increases in the synthesis of a methadone intermediate (184) has been described by Poupaert et al.2s 1 The yield is higher (86%) and the selectivity 184/185 increased compared to the method using toluene and NaH. In fact, the improvement is probably due to a difference in reactivity of the aziridinium ion intermediate. 

Methadone generally lasts about one day in the body, meaning that a person in a maintenance program has to take methadone at least once a day. Federal regulations require that to be eligible for enrollment in a methadone maintenance program, potential patients must be at least 18 years of age and demonstrate that they have had at least a one-year history of heroin (or other opiate) addiction. An exception is made for patients between the ages of 16 and 18 who can document a history of at least two unsuccessful detoxification trials. 

One day, Shannon saw a picture of woman with the caption, "I saw a dog and thought if I was a dog I wouldn t be addicted to heroin. I wish I was a dog." She managed to find a slot in a methadone clinic, where she took a dose of methadone daily to keep the heroin craving away and was able to enjoy life again. Unfortunately, there are not nearly enough openings in treatment centers for all the heroin addicts who want to be free again. 

Correct choice = A. Methadone shows an analgesic action similar to that of morphine. Methadone is effective for 15 to 20 hr, whereas morphine acts for 4 to 6 hr. A major advantage of using methadone in the controlled withdrawal of heroin and morphine abusers is that it can be given orally. 

As with several other drugs, for example marijuana, PCP, and LSD, cocaine can precipitate panic disorder, which continues long after drug withdrawal (177). Among 280 patients in a methadone maintenance clinic, the prevalence of panic disorder increased from 1% to 6% over a decade (178). A marked rise in the frequency of cocaine abuse coincided with this outbreak. The authors suggested that episodes of panic occurring in cocaine users can result in hospitalization for either psychiatric or medical illnesses. 

A 32-year-old man in a methadone program developed dysarthria, bradykinesia, and ataxia after smoking heroin. CT scans showed symmetric hypodensities in the cerebellum with sparing of the dentate nuclei. There were abnormal signals in the internal capsule and optic radiations., although not as extensive as in those who died. 

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