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Psychological Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Harrison Howarth, Jim Bolton, Gary Bell
The prognosis depends primarily on the individual's motivation. One study found 57% of patients with opioid dependence were on methadone maintenance therapy, while 23% were abstinent 2–3 years after inpatient treatment. Naltrexone, an opioid antagonist, is now the preferred treatment for opioid abstinence.
Adherence Issues in Methadone Treatments for Opiate Dependence
Published in Lynn B. Myers, Kenny Midence, Adherence to Treatment in Medical Conditions, 2020
Maintenance approaches to treatment are still controversial, with critics arguing that they can protract addiction and contribute to more general availability of opiates when prescribed methadone is diverted to the illicit market, but most evaluations show fairly clear benefits. One recent review (Bertschy, 1995) concluded that, although results vary, the treatment does have an authentic effect on criminality, HIV risks, mortality and social functioning as well as on illicit drug use, with between 50% and 80% of patients studied not having used heroin in the previous month. Outcomes were to some extent related to patient characteristics, but were much more strongly related to treatment variables. For example, McGlothlin and Anglin (1981) compared two programmes that operated high dose, long retention policies with one that provided low dose, limited duration programmes. Treatment was completed for 12% and 18% of patients in the first two programmes, compared with only 2% of those in the third, and the drop-out rates (where patients themselves stopped attending) were 10% and 16% in the first two compared with 29% in the third. Duration of treatment is a critical influence on long-term outcome, and one extensive review of follow-up studies concluded that “length of time spent in methadone maintenance is related in some way to post methadone maintenance behaviour” and that “more than two to three years of methadone maintenance is necessary before significant behaviour change is observed” (Ward, Mattick and Hall, 1992).
Opium Derivatives
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Patients selected for methadone maintenance are usually those with a prolonged habit, usually of several years duration. Those without family, economic, and employment support systems or who have failed in other treatments are usually directed to such programs when they are available. Some clinics only accept clients with families and jobs, but most have a substantial population of the unemployed.13 The most common clinic procedure favors lower doses of methadone for maintenance. The side effects are less and the supervisory problems somewhat simplified,14 but there is substantial evidence that retention in therapy is greater with high-dose programs.15
Exploring the effectiveness of methadone treatment from the perspective of drug users and their families: a qualitative study in Iran
Published in Journal of Social Work Practice in the Addictions, 2020
Ebraheim Ezzati, Amir Jalali, Ali Hasanpour-Dehkordi
Methadone maintenance treatment is a well-recognized interventive approach that is frequently used in the treatment of opioid users (Dehkordi et al., 2016). Methadone treatment improves the patient’s physical and emotional problems in addition to reducing the craving for opioids (Jalali et al., 2015). Although it is not considered euphoric, methadone is a synthetic material with physiological and analgesic properties similar to that of opium and heroin (Roohani et al., 2012). Upon the prescription of methadone and withdrawal from opium and heroin use, the patient has not entirely quit the use of a drug, but has become addicted to a less dangerous substance (Jalali et al., 2015; Marissen et al., 2006). Many studies have pointed out the cost-effectiveness of methadone (Mohammad-Razzaghi, 2005) and have referred to methadone treatment as an effective treatment method (Barnett & Hui, 2000).
Associations between Medication Assisted Therapy Services Delivery and Mortality in a National Cohort of Veterans with Posttraumatic Stress Disorder and Opioid Use Disorder
Published in Journal of Dual Diagnosis, 2020
Natalie B. Riblet, Daniel J. Gottlieb, Brian Shiner, Sarah L. Cornelius, Bradley V. Watts
The optimal amount or duration of exposure to MAT for OUD is unknown (National Academies of Sciences, Engineering & Medicine, Health & Medicine Division & Board on Health Sciences Policy, 2018). However, the National Institute on Drug Abuse (2019) has stated that patients require a minimum of 12 months of methadone maintenance treatment. In lieu of the limited evidence and the fact that our cohort included only one year of follow-up, we selected cutoff points for high versus low adherence to MAT based on the data distributions. We selected values that ensured that each subgroup size was between one-half and two-thirds the size of the overall group. We made this decision because this approach would allow us to maximize power given the limited sample size and relatively rare outcomes.
Pharmacotherapeutic strategies for the treatment of attention-deficit hyperactivity (ADHD) disorder with comorbid substance-use disorder (SUD)
Published in Expert Opinion on Pharmacotherapy, 2019
Giulio Perugi, Alessandro Pallucchini, Salvatore Rizzato, Pietro De Rossi, Gabriele Sani, Angelo GI Maremmani, Vito Pinzone, Icro Maremmani
Interestingly, preliminary evidence [39] suggest that treatment with stimulant and non stimulants drugs had no clear advantages over placebo with regard to ADHD symptoms, in patients treated with methadone maintenance treatment. This observation is consistent with our experience of a scarce utilization of stimulant and non stimulant drugs in this population. One possible explanation is that patients that benefit from methadone maintenance treatment usually show a personal history of chronic substance use, causing symptoms mimicking ADHD or worsening symptoms of preexisting ADHD. Therefore, in these patients the improvement in SUD may contribute to a better control of such symptoms as a corollary effect of the reduced drug use. On the other hand the chronicity of the addictive behavior may have reduced the sensitivity of the dopaminergic and noradrenergic systems of these subjects reducing the efficacy of ADHD specific drugs.