Methadone maintenance programs

At present in the United States, methadone is the most commonly used drug to treat withdrawal symptoms. Detoxification can be accomplished over a period as long as 6 months in an ambulatory methadone maintenance program or as brief as several days in a hospital setting. The goal in brief detoxification is to make the experience less distressing, but the suppression of all with-... 

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

Ling W, Weiss DG, Charuvastra VC, et al Use of disulfiram for alcoholics in methadone maintenance programs. Arch Gen Psychiarry 40 851—854, 1983 Ling W, Charuvastra C, Collins JF, er al Buprenorphine maintenance treatment of opiate dependence a multi-center, randomized clinical trial. Addiction 93 475-486, 1998... 

Kosten TR, Rounsaville BJ Kleber HD (1985). Parental alcoholism in opioid addicts. Journal of Nervous and Mental Disease, 173, 461-9 Kott A, Habel E Nottingham W (2001). Analysis of behavioral patterns in five cohorts of patients retained in methadone maintenance programs. The Mount Sinai Journal of Medicine, 68, 46-54 Krabbe PF, Koning JPF, Heinen N, Laheij RJF, Victory Van Cauter RM De Jong CAJ... 

This is the goal of methadone maintenance programs. Apparently, when properly administered, these have had considerable worldwide success in countering the adverse effects of heroin addiction. Nevertheless, as a matter of public policy, they have been controversial in the United States partly because they are thought merely to replace one addiction with another (Lowinson et al. 1997 Kreek and Reisinger 1997). 

When used as a cough suppressant, methadone is taken in a liquid or tablet form in very small (1-2 mg) doses every four to six hours. For relief of moderate to severe pain, it is generally given as a tablet or as an intramuscular injection, 2.5-20 mg every three to four hours. When used in heroin detoxification and methadone maintenance programs, it is given as oral tablets, biscuits, or liquid, 20-120 mg every 24-48 hours. 

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. 

In a randomized, double-bhnd, placebo-controlled trial of the efficacy of intravenous methylnaltrexone (0.015-0.095 mg/kg) in treating chronic methadone-induced constipation in 22 patients attending a methadone maintenance program (oral methadone linctus 30-100 mg/day), methylnaltrexone induced immediate bowel movements in all subjects (32). There were no opioid withdrawal symptoms or significant adverse effects. 

There has been a cross-sectional survey of 238 patients in New South Wales who died during a methadone maintenance program in a 5-year period (21). There were 50 deaths (21%) in the first week of methadone maintenance... 

Although long-term administration of low-dose opioids, especially intrathecally, improves quality of life through improved pain control, it can compromise it by causing impaired sexual function. Low testosterone concentrations have been reported in heroin addicts (42) and subjects in a methadone maintenance program (43). 

Methadone maintenance treatment typically involves administration of a daily, prescribed dose of methadone to block the addict s cravings for heroin. Usually methadone maintenance programs are outpatient so that the individual may pursue activities that build a socially productive life. Furthermore, many programs (and state or federal regulations) require patients to receive some kind of counseling while... 

Methadone maintenance programs provision of daily oral doses to registered clients at methadone clinics. 

The administration of phenytoin to patients in methadone maintenance programs has led to symptoms of opioid overdose, including respiratory depression Although ethosuximide has a half-life of approximately 40 hours, the drug is usually taken twice a day... 

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