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Substance Abuse during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Methadone is a synthetic opiate narcotic structurally similar to propoxyphene. Methadone is principally used medically is as opiate maintenance therapy for heroin addiction. It is also used illegally as a substitute for heroin. No studies of methadone abuse are published. Published studies include only pregnant women on regimented-dose maintenance therapy in treatment who took methadone of known pharmacological purity.
Lifestyle and Diet
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Methadone is a chiral synthetic analgesic compound used for the treatment of heroin or opioid dependency. This therapy by substitution needs a therapeutic monitoring control of the two methadone enantiomers in biological fluids of the addict for the efficacy of methadone treatment because only one methadone enantiomer is active and varies with each individual (133). Methadone treatment can help eradicate heroin or opium addiction in drug addicts.
Drug abuse in pregnancy: Marijuana, LSD, cocaine, amphetamines, alcohol, and opiates
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Jacquelyn C. Howitt, Anita Bublik-Anderson
Methadone for the treatment of opiate abuse is highly regulated: it must be administered at a specially licensed facility. Patients typically present weekly to get their medication, which is usually in the range of 60 to 150 mg. (In pregnancy, the lowest dose possible to prevent withdrawal symptoms is recommended.) Methadone is usually taken orally and has a half-life of 24 to 36 hours. It has a long duration of action and extensive, nonspecific tissue binding. Peak plasma levels occur about 4 hours after the ingestion of a maintenance dose (74). Metabolism occurs primarily in the liver, and methadone is excreted in feces and urine (85). Both the placenta and the fetus can further metabolize metha-done (85). Neonatal withdrawal from methadone maybe more severe than that from other opiates (83), may be prolonged (80,83), and may not occur until 2 to 4 weeks after birth.
Assessing cardiac safety among clients receiving methadone as part of opioid agonist maintenance therapy (OAMT) in Durban, South Africa
Published in Journal of Addictive Diseases, 2023
Dorcas Rosaley Prakaschandra, Andrew Scheibe, Monique Marks, Datshana Prakesh Naidoo
The resolution of opioid use disorder2 is challenging. The World Health Organization (WHO) recommends opioid agonist maintenance therapy (OAMT) for the treatment of opioid use disorder2,3 and lists methadone as an essential medicine for this indication.4 Methadone reduces symptoms of opioid withdrawal by acting on opioid receptors in the brain and does not produce the euphoric effects of other opioids.5 The WHO recommends that the average daily methadone dose should be between 60 and 120 mg per day. Dosing within this therapeutic range results in better client retention in treatment than doses <40 mg daily.4 Buprenorphine and naltrexone are also used for the treatment of opioid use disorder and are collectively termed medications for opioid use disorder (MOUD). Despite recommendations for use, access to OAMT remains limited.6,7
Case report: rapid inpatient methadone titration during pregnancy
Published in Journal of Substance Use, 2022
Despite observational evidence to support the need for increased methadone doses during pregnancy (Albright et al., 2011), pharmacologic studies that focus on metabolism and clearance of methadone during pregnancy are few and in general have small sample sizes. The available evidence suggests that methadone serum levels and elimination half-life are significantly decreased in pregnancy (Bogen et al., 2013; Wolff et al., 2005) and that clearance rates increase gradually across the three trimesters (Wolff et al., 2005). This is believed to be related to increased volume of distribution, increased renal clearance, and increased expression of cytochrome P450 enzymes that are responsible for methadone metabolism (Bogen et al., 2013). The continuous metabolic adaptations that occur during pregnancy necessitate access to frequent follow-up to allow for titration of methadone doses based on clinical symptoms.
Attitudes and beliefs among Georgia addiction treatment staff about medication for opioid use disorder in adolescents, young adults, and adults: a multi-mixed methods study
Published in The American Journal of Drug and Alcohol Abuse, 2022
Justine W. Welsh, Maggie J. Mataczynski, Lora L. Passetti, Brooke D. Hunter, Mark D. Godley
Despite increased awareness and education surrounding MOUD, several barriers to its use were noted. If recommended, MOUD was considered acceptable under strictly defined parameters. Some responders expressed concerns about its potential for misuse by the client or his/her family members, in combination with other substances, overdose, and diversion. Withdrawal from MOUD was viewed as extremely problematic and significant enough to warrant avoidance of its use by some participants. These concerns are explained below. [M]ethadone and Bup. These are not helpful in the long run. It is harder to get off of them then the opiates they were using.Suboxone and methadone are addictive themselves and clients depend on that long-term. They are often more painful to detox from than the opiates themselves.