•Compared to placebo, adjuvant ginseng improved sexual functions.•Both female and male individuals reported improvements in sexual functions.•Ginseng appears to be a valuable add-on to treat ...methadone-induced sexual dysfunction.
While methadone maintenance therapy (MMT) in patients with opioid use disorder (OUD) decreases the risk of substance use relapses and criminal and risky sexual behavior, a major disadvantage is its negative impact on sexual function. In the present study we tested whether, compared to placebo, ginseng extract ameliorates methadone-related sexual dysfunction among female and male patients with OUD and receiving MMT.
A total of 74 patients (26 females: mean age: M = 39.0 years; 48 males; mean age: 40.64 years) took part in a double-blind, randomized and placebo-controlled study. Female and male patients were separately randomly assigned either to the ginseng or to a placebo condition. At the beginning of the study and four weeks later, patients completed questionnaires on sexual function.
Irrespective of gender, sexual function improved over time, but more so in the ginseng condition than in the placebo condition.
Ginseng appears to counteract the sexual dysfunction resulting from methadone use in both female and male patients with OUD and undergoing MMT.
Methadone, an opioid agonist, is the recommended treatment for pregnant women with opioid use disorder (OUD). Fetal/neonatal autopsy findings as well as placental changes in the setting of maternal ...OUD or methadone maintenance therapy (MMT) are not well-characterized. Here we present a case of a neonate who had exposure to MMT while in utero and died shortly after birth and was subsequently found to have multifocal calcified renal vein thrombosis, a recent inferior vena cava thrombus, and placental features of fetal vascular malperfusion at autopsy.
•Opioid-dependent patients with chronic pain are more likely to misuse benzodiazepines.•Opioid-dependent patients with chronic pain are more likely to misuse cannabinoids.•Opioid-dependent patients ...with chronic pain are not more likely to misuse opioids.•This pattern of substance misuse is shown to persist in the longer term.
Aims: To compare specific substance misuse in treatment-seeking, opioid-dependent patients with and without comorbid chronic pain, and to assess the respective value of urinalysis and patient reports in assessing substance misuse.
Methods: Participants comprised a clinical population in a regional NHS Substance Misuse Service in the East of Scotland (N = 521). The Brief Pain Inventory – Short Form was used to assess pain, and the Maudsley Addiction Profile and urinalysis were used to assess substance misuse at study inception. Urinalysis was used to assess substance misuse during the 5-year follow-up period. Data were hosted, linked, anonymized and analyzed within a national Safe Haven.
Results: Compared with opioid-dependent patients with no pain, a significantly higher proportion of treatment-seeking, opioid-dependent patients with chronic pain were engaged in non-medical benzodiazepine use (69% versus 58%; p = 0.016) and illicit cannabinoid use (84% versus 65%; p = 0.025) at study inception. Furthermore, a significantly higher proportion of this group was shown to continue non-medical benzodiazepine use (70% versus 42%; p = 0.037) and illicit cannabinoid use (100% versus 31%; p = 0.002) during the 5-year follow-up period. There were significant correlations between drug screen results and patient-reported use of opioids (Tetrachoric ϱ = 0.4944; p < 0.001), benzodiazepines (Tetrachoric ϱ = 0.2641; p = 0.001) and cannabinoids (Tetrachoric ϱ = 0.8384; p < 0.001).
Conclusions: Whilst gaining control of illicit opioid use during treatment, opioid-dependent patients with comorbid chronic pain demonstrated persistent problematic use of benzodiazepines and cannabinoids. This pattern of misuse was shown to persist during the 5-year follow-up period.
Psychosocial combined with methadone maintenance treatment aimed at opioid use disorder is effective, but the efficacy of the psychosocial intervention in such treatment is questionable.
This study ...aims to evaluate the effectiveness of psychosocial plus methadone maintenance treatment versus methadone maintenance treatment alone for opioid use disorder in improving treatment retention and reducing drug use.
An exhaustive literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure database, "the Wan Fang database, the VIP database, and the Chinese Biomedical Literature Database", and randomized controlled trials were identified from their inception to February 2021.
Twenty-four studies were included. The results of this meta-analysis showed that adding any psychosocial treatment to standard methadone maintenance treatment significantly improved the illicit drug use during the treatment relative risk (RR) 0.62 (95% CI 0.48 to 0.79), and retention in treatment RR 1.18 (95% CI 1.11 to 1.25). No statistically significant additional benefit was detected in terms of retention at follow-up RR 1.08 (95% CI 0.95 to 1.22).
The present evidence suggests that adding psychosocial intervention to methadone maintenance treatment significantly improves the nonuse of opioids and retention in treatment. It should be noted that psychosocial treatment is only beneficial for methadone treatment when methadone is provided in subtherapeutic doses. Additionally, the finding about the improvement effect of retention at follow-up did not achieve statistical significance. Due to the diversity of outcome indicators in relevant original studies, the included studies are limited.
Background and aims
Previous research has found diacetylmorphine, delivered under supervision, to be cost‐effective in the treatment of severe opioid use disorder, but diacetylmorphine is not ...available in many settings. The Study to Assess Long‐term Opioid Maintenance Effectiveness (SALOME) randomized controlled trial provided evidence that injectable hydromorphone is non‐inferior to diacetylmorphine. The current study aimed to compare the cost‐effectiveness of hydromorphone directly with diacetylmorphine and indirectly with methadone maintenance treatment.
Design
A within‐trial analysis was conducted using the patient level data from the 6‐month, double‐blind, non‐inferiority SALOME trial. A life‐time analysis extrapolated costs and outcomes using a decision analytical cohort model. The model incorporated data from a previous trial to include an indirect comparison to methadone maintenance.
Setting
A supervised clinic in Vancouver, British Columbia, Canada.
Participants
A total of 202 long‐term street opioid injectors who had at least two attempts at treatment, including one with methadone (or other substitution), were randomized to hydromorphone (n = 100) or diacetylmorphine (n = 102).
Measurements
We measured the utilization of drugs, visits to health professionals, hospitalizations, criminal activity, mortality and quality of life. This enabled us to estimate incremental costs, quality‐adjusted life years (QALYs) and cost‐effectiveness ratios from a societal perspective. Sensitivity analyses considered different sources of evidence, assumptions and perspectives.
Findings
The within‐trial analysis found hydromorphone provided similar QALYs to diacetylmorphine 0.377, 95% confidence interval (CI) = 0.361–0.393 versus 0.375, 95% CI = 0.357–0.391, but accumulated marginally greater costs $49 830 ($28 401–73 637) versus $34 320 ($21 780–55 998). The life‐time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone 8.4 (7.4–9.5) and 8.3 (7.2–9.5) versus 7.4 (6.5–8.3) QALYs at lower cost $1.01 million ($0.6–1.59 million) and $1.02 million ($0.72–1.51 million) versus $1.15 million ($0.71–1.84 million).
Conclusions
In patients with severe opioid use disorder enrolled into the SALOME trial, injectable hydromorphone provided similar outcomes to injectable diacetylmorphine. Modelling outcomes during a patient's life‐time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost‐saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.
Methadone maintenance treatment (MMT) is the most common treatment for opioid-dependent pregnant women worldwide. Despite its widespread use, MMT is associated with a variety of adverse ...neurodevelopmental outcomes in exposed offspring, particularly cognitive impairments. The neurobiological abnormalities underlying these cognitive impairments are, however, poorly understood. This is, in part, due to a lack of animal models that represents the standard of care that methadone is administered in the clinic, with inconsistencies in the timing, doses and durations of treatment. Here we describe the characterisation of a clinically relevant rat model of MMT in which the long-term behavioural and neurobiological effects of prenatal methadone exposure can be assessed in adolescent offspring. Female Sprague-Dawley rats were treated orally with an ascending methadone dosage schedule (5, 10, 15, 20, 25 and 30 mg/kg/day), self-administered in drinking water prior to conception, throughout gestation and lactation. Pregnancy success, maternal gestational weight gain, litter survival and size were not significantly altered in methadone-exposed animals. Methadone-exposed offspring body and brain weights were significantly lower at birth. Novel object recognition tests performed at adolescence revealed methadone-exposed offspring had impaired recognition memory. Furthermore, the rewarded T-maze alternation task demonstrated that methadone-exposed female, but not male, offspring also exhibit working memory and learning deficits. Immunoblots of the adolescent prefrontal cortex and hippocampus showed methadone-exposed offspring displayed reduced levels of mature BDNF, in addition to the GABAergic proteins, GAD67 and parvalbumin, in a sex- and brain region-specific fashion. This rat model closely emulates the clinical scenario in which methadone is administered to opioid-dependent pregnant woman and provides evidence MMT can cause cognitive impairments in adolescent offspring that may be underlined by perturbed neurodevelopment of the GABAergic system.
•Development of a novel rat model of maternal methadone treatment that aims to recapitulate clinical treatment scenario.•Prenatal methadone exposure caused recognition memory deficits in male and female adolescent offspring.•Prenatal methadone exposure caused learning deficits in adolescent female offspring.•Prenatal methadone exposure resulted in sex- and brain region-dependent reductions to GAD67 and parvalbumin protein levels.
Cannabis and opioids are substances that affect reproductive health. Opioids suppress testosterone and studies have shown that cannabis may increase testosterone. However, there is minimal research ...describing the endocrine effects of concurrent cannabis and opioid use. We hypothesize that cannabis use improves opioid-induced testosterone suppression. To test this hypothesis, we used cross-sectional data from a prospective cohort study including 122 men enrolled in methadone maintenance treatment (MMT). We measured serum testosterone with an enzyme-linked immunosorbent assay at study enrolment. Urine drug screens were collected for 15 months and identified 52.5% of participants (n = 64) as cannabis users. The association between cannabis use and testosterone level was examined using regression models with serum testosterone as the dependent variable. In our multivariable regression, methadone dose was associated with lower serum testosterone (β = −0.003, 95% CI-0.005, −0.001, p = 0.003). However, neither cannabis use as a dichotomous variable nor the percentage of cannabis-positive urine drug screens were significantly associated with serum testosterone (β = 0.143, 95% CI −0.110, 0.396, p = 0.266, and β = 0.002, 95% CI > −0.001, 0.005, p = 0.116, respectively). Therefore, it does not appear that cannabis has an association with testosterone levels in men on MMT.
The current study examined the association between subjective cognitive dysfunction and objective test performance in persons enrolled in drug treatment and stabilized on methadone maintenance ...therapy (MMT). A total of 177 participants completed the self-reported brief inventory of neurocognitive impairment (BINI) and NIH Toolbox test battery. In participants with neurocognitive dysfunction, scores on all BINI subscales were negatively associated with objective performance on the NIH Toolbox (BINI Global r = −0.26, p = 0.01; BINI Subscales ranging −0.22 to −0.32, all p's < 0.03). Using cutoff scores, results showed participants who scored above the cutoff on the BINI Learning subscale demonstrated significant evidence of objective neurocognitive dysfunction on the NIH Toolbox (65% vs. 35%; χ
2
= 6.57, p = 0.02), suggesting possible clinical utility. Future studies are needed to determine the feasibility of using the BINI to inform the accommodation of patients with specific neurocognitive profiles to optimize treatment outcomes.
PDF
