Methadone treatment

Hien DA, Nunes E, Levin FR, et al Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat 19 31-37, 2000 Himmelsbach CK The morphine abstinence syndrome, its nature and treatment. Ann Intern Med 13 829-839, 1941... 

Maany I, Dhopesh V, Arndt lO, et al Increase in desipramine serum levels associated with methadone treatment. Am J Psychiatry 146 1611—1613, 1989 Maas U, Kattner E, Weingart-Jesse B, et al Infrequent neonatal opiate withdrawal following maternal methadone detoxification during pregnancy. J Perinat Med 18 111-118, 1990... 

Studies have shown that CM can be used to directly reinforce adherence to medication treatments as well (Petty 2000). Liebson et al (1978) found that methadone-maintained alcohol-dependent patients reduced alcohol use when methadone treatment was contingent on disulfiram consumption. To date, one of the most common applications of CM techniques to pharmacotherapy has been the provision of vouchers or cash contingent upon naltrexone consumption in recently detoxified opioid-dependent patients (Carroll et al. 2001, 2002 Preston et al. 1999). These studies have generally reported significant increases in retention and reductions in opioid use among patients receiving the CM treatment, relative to other therapies. 

BCT also can reduce drug use and improve psychosocial problems when combined with methadone treatment. Fals-Stewart et al. (2001) randomly as-... 

St. John s wort This herbal remedy may induce CYP3A4 the certainty of an interaction probably rests on the specific preparation being used, but caution would dictate that this herbal product should be avoided in those receiving methadone treatment withdrawal symptoms have been noted in patients taking methadone maintenance who have added St. John s wort to their drug regimen. 

Even though methadone treatment reduces the high mortality of intravenous addicts to about 30% of controls, a number of patients and non-patients still overdose on methadone itself (Vormefelde and Poser, 2000), although the availability of methadone itself does not appear to be linked to increases in drug-related deaths (Oliver, 2002). 

Outcomes in time-limited methadone treatment have generally been found to be very poor in comparison with maintenance (McGlothin Anglin 1981, Gossop et al. 2001, Magura Rosenblum 2001), although the early influential studies were typically in established maintenance candidates who had treatment restricted, rather than individuals who chose to reduce as an option within a flexible policy. For our purposes this intermediate duration of treatment, which now applies just as much to buprenorphine, is classed as slow detoxification, and is discussed in the section on detoxification from the two medications. 

A comparison between the medical model of methadone treatment and a model of methadone as a so-called heroin substitute is outlined in Table 1.2, and these concepts will now be considered. 

Table 1.2 Medical model and substitution model of methadone treatment...

Table 1.3 Main areas of benefit in methadone treatment...

In the reviews cited in this chapter there is often some breakdown of findings into those relating to heroin use, criminality, HIV-risk behaviours, social rehabilitation and nonopiate abuse. We have noted that crime was one of the earliest indicators in methadone treatment, while the wider range of outcomes is formalized in drug misuse rating instruments such as the Opiate Treatment Index (Darke et al. 1992a). The main areas in which methadone treatment has been found to be of substantial benefit are indicated in Table 1.3. 

In Table 1.3 I have included the areas of physical and psychological health, which often do not feature in reviews. Methadone has significant adverse effects, as discussed below, and by no means do all patients report subjective improvements in health on the drug, as opposed to when taking street heroin or other opiates. However, if methadone treatment is adhered to, there is normalization of various circadian rhythms and endocrine effects... 

Following the evolution of methadone treatment internationally, as summarized earUer in the chapter, in many clinics medical and counselling appointments are at about that monthly frequency, with general drug counselling mainly on an individual basis. In our... 

The nature of methadone treatment, and the common complications which often occur in respect of appointments and unplanned presentations, make some kind of contract between patient and clinic desirable. In health services the standard of information given to users about basic matters such as opening hours, appointment systems and prescriptions has... 

As far as possible, methadone treatment should mean just that, not methadone plus other medications of potential misuse. The theoretical footing for this is that the majority of the positive evidence for effectiveness relates to methadone alone, although we noted earlier that the main studies did not include individuals who were significant users of non-opiate drugs. 

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