Abstract Because it is not common in the U.S. for jails to allow inmates to continue opioid medications that have been started in the community, we aimed to assess whether inmates maintained on ...methadone showed different rates of recidivism, lengths of incarceration, and types of offenses than other incarcerated groups. We also analyzed rates of return to home clinics after release. In order to answer these questions this study used extant data from 960 adult inmates in a large metropolitan detention center who were in 1 of 4 groups: general population with no known substance use disorders, alcohol detoxification, methadone maintenance (MMT), and opioid detoxification. Recidivism was assessed for 1 year after release. Data were collected from medical screening forms and jail databases and included demographic variables, dates of admission and release, number of doses and total dosage of methadone if applicable, reason for incarceration, and the date of rebooking and nature of offense, if it occurred. There was a significant difference in time to rebooking, F (3956) = 13.32, p = .00, with the MMT group taking longer to be rebooked (275.6 days) than the opioid (236.3 days) and alcohol detoxification groups (229.3 days), but not the general population group (286.2 days). Survival analysis indicated significantly better survival without rebooking in the MMT and general population groups than the alcohol and opioid detoxification groups. There also were differences in length of incarceration, F (3, 954) = 9.02, p = .00, with the MMT group being incarcerated longer than other substance using groups; and in misdemeanor vs. felony rebooking offenses, χ2 3 = 31.29, p < .01, with the opioid detoxification group being more likely to have a felony rebooking than the general or alcohol groups. In a separate analysis, data from 137 MMT clients, who were not precisely the same clients who were involved in other analyses reported in this article, indicated that over 97% returned to their home methadone clinics after incarceration. In summary, inmates who had been allowed to be maintained on methadone started in the community displayed a significantly longer time to be rearrested than inmates undergoing opioid or alcohol detoxification, but not inmates without substance use disorders. When they were rebooked, they were as likely as the opioid detoxification group to be rearrested for felony offenses.
Highlights • CYP2B6 polymorphisms contribute to variations in methadone pharmacokinetics. • CYP2B6*6 carriers had shorter pain threshold than CYP2B6*6 non-carriers. • Pain tolerance was also shorter ...in the CYP2B6*6 carriers. • CYP2B6*6 influences pain sensitivity among patients on methadone maintenance therapy.
Abstract Introduction We conducted a follow-up study to evaluate the outcome of a heroin-dependent population 25 years after their first enrollment in methadone maintenance treatment (MMT). We ...assessed mortality in the sample plus actual drug use, treatment, and medical factors associated with drug dependence, focusing on possible gender differences. Methods Prospective follow-up study of 214 heroin-dependent patients consecutively admitted for MMT between 1980 and 1984 in the Asturias Public Health Service. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. An ad-hoc protocol on drug misuse and treatment, drug-related morbidity and Clinical Global Impression (CGI) scores were assessed in the survivors' sample. Results Information was received on 159 subjects, 106 of whom were deceased. Men accounted for 76.2% of the study cohort. Over the 25-year follow-up period, the SMR was 22.51 (95% CI = 22.37–22.64). In the survivors sample, 39.6% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 47.2% and hepatitis B/C in 81.1%; current heroin use was reported by 22.6%. There were no gender differences in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 25-year follow-up compared with 31.1% of males. Conclusions This study confirms the high mortality of heroin addicts even after enrollment in MMT. Severity of the addiction in terms of mortality was similar in both genders. Women who survived the 25-year follow-up were more likely to have stopped using heroin than men.
Methadone maintenance therapy (MMT) treats opioid use disorder among people who inject drugs (PWID). To understand why PWID may voluntarily discontinue MMT, we analyzed data from 25 focus groups ...conducted in five Ukrainian cities from February to April 2013 with 199 participants who were currently, previously, or never on MMT. Using constant comparison method, we uncovered three themes explaining why PWID transition off MMT: (a) purposeful resistance to rigid social control associated with how MMT is delivered and to power asymmetries in provider–patient relationships, (b) self-management of a PWID’s “wounded identity” that is common in socially stigmatized and physically sick persons—MMT serves as a reminder of their illness, and (c) the quest for a “normal life” uninterrupted by daily MMT site visits, harassment, and time inefficiencies, resources, and social capital. Focusing on holistic principles of recovery would improve addiction treatment and HIV prevention in Ukraine and globally.
We examined the association of methadone maintenance therapy (MMT) with highly active antiretroviral therapy (HAART) adherence and HIV treatment outcomes among a cohort of HIV/HCV co-infected ...injection drug users (IDUs).
We obtained demographic, drug use, and addiction care history from the Vancouver Injection Drug User Study (VIDUS), which is an open cohort study of IDUs. The questionnaires were longitudinally linked to the British Columbia HIV/AIDS Drug Treatment Program to obtain HAART adherence and HIV treatment outcome data. There were 278 VIDUS participants who accessed HAART from August 1, 1996 to November 24, 2003. We constructed longitudinal logistic models using generalized estimating equations to examine the independent associations between methadone maintenance therapy and the following outcomes: HAART adherence; plasma HIV-1 RNA suppression; and CD4 cell rise of 100
cells/mm
3.
Among participants who reported at least weekly heroin use, MMT was independently associated with lower odds of subsequent weekly heroin use during the follow-up period (adjusted odds ratio; 95% confidence interval AOR; 95% CI: 0.24; 0.14–0.40). We also found that MMT was positively associated with adherence (AOR 1.52; 95% CI 1.16–2.00), HIV-1 RNA suppression (AOR 1.34; 95% CI 1.00–1.79), and CD4 cell count rise (AOR 1.58; 95% CI 1.26–1.99).
Among HIV/HCV co-infected IDUs on HAART, enrollment in MMT was associated with reduced heroin use, and improved adherence, HIV-1 RNA suppression and CD4 cell count response. Integrating opiate addiction care and HIV care may provide improved health outcomes for this vulnerable population and should be further explored.
Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed ...to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa.
We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency.
The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).
Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
Summary Objectives The methadone maintenance therapy (MMT) programme has been scaled up rapidly in China. This study explored the family support perceived by MMT clients and its association with ...their quality of life and concurrent illicit drug use. Study design Cross-sectional study. Methods Five hundred and sixty MMT clients were selected at random from 28 MMT clinics and services in Zhejiang and Jiangxi Provinces, China for participation in a face-to-face interview study. The participants’ perceived family support and quality of life were measured through face-to-face structured interviews conducted by trained interviewers. Self-reported information about illicit drug use was obtained from clients. Urine specimens were collected from the participants to test for heroin use. Results Among the 560 participants, 471 (84.1%) were male and 168 (30.0%) were unemployed at the time of the study. In total, 398 (71.1%) were injecting drug users and 309 (55.2%) had a history of drug use of more than 10 years. Around one-third ( n = 211, 37.7%) of the participants reported concurrent illicit drug use or had a positive urine test. Perceived family support was associated with increased physical health, psychological health, environmental health and social health. In addition, perceived family support was negatively correlated with concurrent substance use. Conclusions Drug use and MMT is a family issue in China. Based on the findings of this study, it is suggested that involving family members in recruitment and interventions of the MMT programme will achieve higher rates of participation and compliance.
Methadone treatment is a conventional treatment with a harm-reduction approach used in addiction treatment. Psychological needs are important factors affecting the retention in treatment for these ...clients. The present study aimed to explore the psychological needs of women treated with methadone. This research was a concurrent mixed-method design. In the quantitative part, 138 female clients were selected using convenience sampling method and were assessed by the Basic Psychological Needs Scale. In the qualitative part, 14 female clients interested in participating in the study were selected using purposive sampling and qualitative data were collected using face-to-face, deep, and semistructured interviews. The qualitative and quantitative data were analyzed using qualitative content analysis, descriptive, and inferential analysis by SPSS software version 25, respectively. The results obtained in the qualitative part consisted of 288 codes, seven subcategories and three major categories including (i.e., family acceptance, need to comfort, and being independent). The quantitative findings revealed that autonomy, competence, and dependence among the clients were above the moderate. The results showed that female drug users throughout the methadone treatment process require the continued support of family and community to cover the psychological needs for retention in treatment.
Sustainability of methadone maintenance treatment (MMT) program involves regularly assessing its impact on health and social outcomes of drug users in different settings, particularly in ...disadvantaged areas. In this study, we evaluated the change in quality of life (QoL), and identified associated factors amongst drug users over the course of 12-month MMT in Vietnamese mountainous provinces.
We conducted a longitudinal study among patients from 6 MMT clinics in three mountainous provinces of Vietnam. At baseline, we screened 300 participants and after a 12-month treatment, 244 participants remained to involve in the study. World Health Organization Quality of Life short form instrument (WHOQOL-BREF) was used to measure the QoL of patients. The magnitude of the changes was extrapolated.
There were significant changes in all four dimensions of quality of life measured by WHOQoL-BREF between baseline and 12 months with the effect size ranged from 0.21 to 0.24. Increased age, being workers compared to unemployment and having health problems or comorbidities were positively related to reduced scores of QoL.
To conclude, we observed a significant increase in the QoL level regarding physical, psychological, social relationships and environmental aspects among people who used drug after 12 months of MMT. Findings from this study emphasize the role of continuously receiving MMT treatment among people using drugs to enhance their QoL.
Hyperalgesia is a common clinical phenomenon among opioid dependent patients on methadone maintenance therapy (MMT) and it may be associated with undertreated pain and/or therapeutic failure. This ...study aimed to investigate association between serum methadone concentration (SMC) and cold pressor pain responses. Cold pressor pain responses in 147 opioid dependent patients on MMT were assessed using cold pressor test (CPT) at 0 h and at 2, 4, 8, 12, and 24 h after the dose intake. Blood samples were collected at 24 h after the dose. Serum methadone concentrations were measured using the Methadone ELISA kit and classified into two categories: < 400 ng/mL and ≥ 400 ng/mL. Eighty-eight patients (59.9%) had trough concentrations of < 400 ng/mL and 40.1% had trough concentrations of ≥ 400 ng/mL. There were significant effects of SMC on the cold pressor pain threshold (
= 0.019). Patients with concentrations < 400 ng/mL had significantly higher (almost 60% higher) cold pressor pain threshold (adjusted mean (95% CI) = 30.15 (24.29, 36.01) s) compared to those with concentrations of ≥ 400 ng/mL (18.93 (11.77, 26.08) seconds). There was also a 20% difference in pain tolerance, and 6% difference in cold pressor pain intensity score, neither of which were significant statistically (
> 0.05). Our results suggest an association of trough methadone concentration with the cold pressor pain threshold among opioid dependent patients on MMT. It would be useful to study the mechanisms underlying this association to help managing pain in such a population.
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