Relation of detoxification fear to methadone maintenance outcome: 5-year follow-up.

Assessed 5-yr treatment outcome follow-up on 56 methadone maintenance patients originally assessed for detoxification fear. Three fear measures (psychometric, interview, and self-report) were associated with treatment outcome variables by canonical correlation, representing 40% shared variance between predictor and predicted variables. Detoxification fear was associated with longer treatment, fewer treatment episodes, fewer methadone detoxification attempts, and fewer successful methadone detoxifications. Findings suggest that detoxification fear is a significant factor that may affect methadone maintenance outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

21-day outpatient methadone detoxification: an evaluation

A population consisting of all consecutive admissions between May 29, 1974 and July 30, 1974 was studied. Of the 169 applicants, 63 began the detoxification regimen. Persons participating in this program were in contact with the program only during their 21-day detoxification episode. The treatment setting was highly permissive. The primary objective was to help and assist individuals in their efforts to either reduce their use of opiates or attain a drug-free state. Thirty-one of the 63 individuals completed the program. Forty-five persons had lower opiate readings when their last three urine samples were analyzed. Interpretation of the data is guarded.     

Love and hate in methadone maintenance

Different peptides of natural origin were studied for their stimulant activity on the stomach of the anaesthetized rat. The group of the tachykinins (substance P and its analogues) showed a noticeable spasmogenic activity on the whole stomach from the fundus to the pylorus. Threshold doses ranged between 0.1 and 5 microgram/kg by i.v. route and the order of potency was: eledoisin greater than phyllomedusin greater than physalaemin greater than uperolein greater than substance P. A good correlation between the dose and the duration of the spasmogenic effect was always observed and tachyphylaxis never occurred. Experiments carried out with different kinds of inhibitors suggested that tachykinins act directly on the smooth muscle of the stomach. Taking into account also results obtained in other experimental conditions it was possible to state that the N-terminal part of the molecule of these peptides has a certain importance in determining the degree of their potency in the different tests. The peptide motilin, which does not belong to the family from a chemical point of view, was scarcely active, if at all, in modifying the motility of the rat stomach.     

Implosive therapy treatment of heroin addicts during methadone detoxification.

Examined the effectiveness of implosive therapy with heroin addicts during detoxification from methadone. 24 Ss with comparable histories of heroin addicition and similar maintenance levels of methadone were assigned to an implosive therapy, eclectic counseling, or control group. The 2 treatment groups received 12 sessions of implosive therapy or eclectic counseling and were followed for a subsequent 6-wk period. The implosive therapy Ss were the only ones to reduce significantly their methadone level during treatment and the follow-up period. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcotics addiction treatment: behavioral methods concurrent with methadone maintenance

Methadone maintenance patients were assigned among four treatment cells involving contingency management, emotionally-based behavior therapy, a combination of these, or a control condition receiving counseling but no behavioral treatment. With 60 patients who remained in treatment at least 6 months, treatment outcomes were compared using objective measures: hours employed, urinalysis results, and counseling participation. No significant differences were found between modalities. Case studies suggested that under appropriate conditions, contingency management might reduce illicit drug use. It is suggested that focused experimental studies may be more productive than broad clinical outcome evaluations.     

Buprenorphine versus methadone maintenance for opioid dependence

Buprenorphine at 2 mg and 6 mg daily was compared with methadone at 35 mg and 65 mg during 24 weeks of maintenance among 125 opioid-dependent patients. As hypothesized, 6 mg of buprenorphine were superior to 2 mg of buprenorphine in reducing illicit opioid use, but higher dosage did not improve treatment retention. Self-reported illicit opioid use declined substantially in all groups, but by the third month, significantly more heroin abuse was reported at 2 mg than at 6 mg of buprenorphine or of methadone. From an initial average of $1860/month, month 3 usage dropped to $41 (methadone 65 mg), $73 (methadone 35 mg), $118 (buprenorphine 6 mg), and $351/month (buprenorphine 2 mg). Days of use also dropped from 29 days to 1.7 (methadone 65 mg), 2.8 (methadone 35 mg), 4.0 (buprenorphine 6 mg), and 6.6 days/month (buprenorphine 2 mg). This relatively low efficacy for 2 mg of buprenorphine persisted through month 6 of the trial, with 7.2 days/month and $235/month of use for buprenorphine at 2 mg versus 1.9 days/month and $65/month for the other three groups. Increased opioid abuse also was associated with significantly greater and persistent opioid withdrawal symptoms. Our secondary hypothesis, that buprenorphine would be equivalent to methadone in efficacy, was not supported. Treatment retention was significantly better on methadone (20 vs. 16 weeks), and methadone patients had significantly more opioid-free urines (51% vs. 26%). Abstinence for at least 3 weeks was also more common on methadone than buprenorphine (65% vs. 27%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of methadone maintenance for heroin addiction

Methadone maintenance programs have effectively reduced heroin dependency and are available in most countries affected by heroin addiction. Methadone, developed in Germany during World War II as a pain killer, does not have the euphoric effects of heroin and the goal of treatment is to substitute methadone for heroin use. Recidivism is probably a life-long risk. Methadone maintenance programs began in the 1960s in the United States in New York City. Once tolerance is developed, it may be used continually without harmful side effects. Dosage is important for effectiveness as are counseling, rehabilitation services, and employment support. Reduction in criminality and AIDS has been associated with methadone maintenance programs.     

Problems associated with implant maintenance

Implants are highly successful alternatives to conventional prostheses when patients are properly selected and sound prosthodontic principles are followed. Yet problems may still be encountered during follow-up exams. The clinician must be educated as to possible problems and adequately prepared to manage the situation.     

Treatment failure and methadone dose in a public methadone maintenance treatment programme in Geneva

PURPOSE: To determine the effect of an anaesthetic with antioxidant potential, propofol, on red blood cell (RBC) antioxidant enzyme activities and RBC susceptibility to peroxidative challenge. METHODS: Propofol was administered by intravenous bolus (2.5 mg.kg-1) and continuous infusion (36 and 72 ml.hr-1 in nine swine; 216 ml.hr-1 in two swine), to achieve serum concentrations between 5 and 30 micrograms.ml-1 for two hours at each rate. Arterial blood sampling was at 0, 10, 30, 60, and 120 min for each rate of infusion, for measurement of plasma propofol concentration, activities of plasma and RBC superoxide dismutase, glutathione peroxidase, glutathione reductase, RBC catalase, and RBC malondialdehyde (MDA) formation in response to ex vivo oxidative challenge with t-butyl hydrogen peroxide (tBHP; 1.5 mM). Antioxidant mechanisms were determined by in vitro study of MDA formation, GSH depletion, and oxidation of haemoglobin to methaemoglobin in human erythrocytes exposed to propofol 0-75 microM. The antioxidant potential of propofol was compared with that of alpha-tocopherol utilising the reaction with 2,4,6-tripyridyl-s-triazine (TPTZ). RESULTS: Propofol had no effect on plasma or RBC antioxidant enzyme activities. It inhibited RBC MDA production over the range of 0-20 micrograms.ml-1 (y = -18.683x + 85.431; R2 = 0.8174). Effective propofol concentrations for 25% and 50% reductions in MDA levels were 7-12 and 12-20 micrograms.ml-1, respectively. Propofol has a similar effect on human erythrocytes in vitro (R2 = 0.98). CONCLUSION: Propofol antagonises the effects of forced peroxidation of red cells at anaesthetic and sub-anaesthetic concentrations in swine. Its actions include scavenging of oxygen derived free radicals in a tocopherol-like manner.     

Cognitive functioning under moderate and low dosage methadone maintenance

The Wechsler Adult Intelligence Scale (WAIS) was administered to two groups of patients in the Santa Clara County Methadone Maintenance Program who were receiving low and moderate daily stabilized dosages of methadone hydrochloride. In the two separate statistical analyses performed, there were no significant differences found between subtest scores or verbal, performance, and full-scale scores of the groups measured. These results, combined with observations regarding the similarities of WAIS profiles of the two groups, indicate that cognitive functioning as measured by the WAIS was not differentially affected by the two dosages.     

Personality disorders and treatment outcome in methadone maintenance patients

This study examined the relationship between personality disorder (PDs) and 7-month treatment outcome in 197 men admitted to methadone maintenance. Subjects reported pervasive improvement, and the amount of improvement did not significantly differ for those subjects with and without PDs. PD subjects entered treatment with more severe self-reported drug, alcohol, psychiatric, and legal problems, and despite progress, remained more problematic in those areas relative to subjects without PDs. Subjects with antisocial PD had admission and 7-month problem status similar to subjects with other PDs. The 7-month urinalysis results for opiates and cocaine showed no significant differences between subjects with and without PDs. Fewer PD subjects stayed in treatment continuously for the 7-month period. Several cluster B PDs-borderline, antisocial, and histrionic-predicted poorest overall outcomes. Methadone-maintained patients with PDs may warrant additional treatment services if they are to approach the functional level of patients without PDs.     

Self-efficacy and illicit opioid use in a 180-day methadone detoxification treatment.

Self-efficacy ratings coincided with illicit opioid use across the 3 phases of a 180-day methadone detoxification treatment. Efficacy ratings increased after patients received their first dose of methadone, did not change while they were maintained on a stable dose of methadone, and declined during the taper as they attempted to face high-risk situations without the full benefit of methadone. Efficacy ratings measured at a point before a phase of treatment predicted illicit opioid use across that phase. For clarification of the relation between self-efficacy and illicit opioid use, 3 conceptual models proposed by J. S. Baer, C. S. Holt, and E. Lichtenstein (see record 1987-13846-001) were tested. Self-efficacy influenced subsequent drug use in parallel with previous behavior, but this influence was found only at the start of the stabilization phase and immediately before the start of the taper phase. These findings highlight the usefulness of the self-efficacy concept for the treatment of opioid addiction (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence-based incentives in methadone maintenance: Interaction with intake stimulant test results.

Baseline drug use detected in urine toxicology has been shown to predict drug abuse treatment outcome, including response to contingency management interventions with drug abstinence as their target. This study examined the association between baseline urine test result and treatment outcome in stabilized methadone maintenance patients with ongoing stimulant use to determine whether abstinence incentives were differentially effective in those testing stimulant negative versus positive at study entry. Participants were 386 methadone-maintained patients who took part in a National Drug Abuse Treatment Clinical Trials Network multisite study aimed at reducing stimulant abuse during treatment (J. M. Peirce et al., 2006). At study intake, 24% of participants tested stimulant negative and 76% tested positive. Those testing negative at entry submitted 82% negative urines during the study versus 36% for those testing positive at entry (odds ratio [OR] = 8.67; confidence interval [CI] = 5.81-12.94). Compared with those receiving usual care, the addition of abstinence incentives resulted in a significant increase in stimulant-negative urine samples submitted during the study both for those testing negative at study entry (OR = 2.27; CI = 1.13- 4.75) and for those testing positive (OR = 1.84; CI = 1.25-2.71). These findings suggest that abstinence incentives have significant clinical benefits independent of initial drug use severity among methadone maintenance patients with ongoing stimulant drug use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems with maintenance therapy in opiate dependence and the clinical importance of methadone]

The author presents a review of experience with substitution treatment in opiate dependence. Methadone treatment is most frequently used. An individual daily dose and long-term substitution are desirable for stabilization and motivation of patients included in the methadone programme. Interaction of methadone with some drugs affects the methadone metabolism and calls for a change of the methadone dose and must not be omitted. In addition to methadone there are also other types of pharmacotherapy of opiate dependence (acetylmethadol, buprenorphine). In the Czech Republic in 1997 in the General Faculty Hospital Prague the methadone programme was started. The importance of methadone substitution treatment is beyond doubt and involves improvement of the psychosocial and health status of addicts, gives an opportunity of resocialization and reintegration into society.     

Drug use and injection risk-taking among prison methadone maintenance patients

AIMS: To examine the drug use and injection risk-taking among incarcerated methadone maintenance (MM) patients; to determine the impact of a diagnosis of antisocial personality disorder (ASPD) on prison-based MM treatment; to compare incarcerated patients with community patients. DESIGN: Structured interview. SETTINGS: New South Wales (NSW) prisons and community methadone maintenance (MM) units. PARTICIPANTS: One hundred incarcerated MM patients and 183 community MM patients. MEASUREMENTS: Subjects were interviewed about drug use and needle risk-taking in the previous 6 months, and assessed for a diagnosis of ASPD. FINDINGS: Heroin had been used by 38% of prison MM patients in the 6 months prior to interview, on a median of 4.5 days. Forty-four per cent of prison patients had injected a drug in the preceding 6 months. A third (32%) of prison subjects had borrowed used injecting equipment within the preceding 6 months, and 35% had lent used injecting equipment to others. Community patients were more likely to have injected a drug in the preceding 6 months (84% vs. 44%), to have used heroin (72% vs. 38%) and to have done so more frequently (20 vs. 4.5 days). Prisoners, however, were more likely to have borrowed (32% vs. 15%) and lent (35% vs. 21%) injecting equipment in that time. While injecting at lower rates than their community counterparts, the injecting occasions of prisoners were of much higher levels of risk. A diagnosis of ASPD was unrelated to both drug use and needle risk-taking. CONCLUSIONS: Incarcerated patients injected less frequently than community patients, but had higher levels of needle risk-taking.     

Response to methadone maintenance and counseling in antisocial patients with and without major depression

This study compared the treatment response of four groups of psychiatrically diverse opiate-dependent, methadone maintenance patients receiving drug counseling. The four groups were patients with no other nonsubstance abuse axis I psychiatric diagnoses (OP only; N = 65), patients with lifetime major depression (DEP; N = 60), patients with both antisocial personality disorder and lifetime major depression (APD + DEP; N = 35), and patients with only APD (APD only; N = 24). Patients were assessed at intake, during treatment, and 7 months after treatment admission. No statistically significant differences were found among the groups in treatment retention/attendance. Few significant group differences were revealed during-treatment urine screens, except that barbiturate use was more common for the APD only group. The APD only group also had significantly more positive urine screens for benzodiazepines than the other three groups at 7-month follow-up. All groups reported considerable improvement in problem level at 7 months compared with admission status. The APD only group reported fewer gains in legal and employment problems than the other groups but reported greater improvement in the drug area. Thus, there was some limited support for a prior finding, based on individual psychotherapy, that the treatment response of APD only patients was inferior to that of APD + DEP patients or non-APD patients.     

Are supplementary services provided during methadone maintenance really cost-effective?

OBJECTIVE: Previous research has suggested that support services supplementing methadone maintenance programs vary in their cost-effectiveness. This study examined the cost-effectiveness of varying levels of supplementary support services to determine whether the relative cost-effectiveness of alternative levels of support is sustained over time. METHOD: A group of 100 methadone-maintained opiate users were randomly assigned to three treatment groups receiving different levels of support services during a 24-week clinical trial. One group received methadone treatment with a minimum of counseling, the second received methadone plus more intensive counseling, and the third received methadone plus enhanced counseling, medical, and psychosocial services. The results at the end of the trial period have been published elsewhere. This article reports the results of an analysis at a 6-month follow-up. RESULTS: The follow-up analysis reaffirmed the preliminary findings that the methadone plus counseling level provided the most cost-effective implementation of the treatment program. At 12 months, the annual cost per abstinent client was $16,485, $9,804, and $11,818 for the low, intermediate, and high levels of support, respectively. Abstinence rates were highest, but modestly so, for the group receiving the high-intensity, high-cost methadone with enhanced services intervention. CONCLUSIONS: This study suggests that large amounts of support to methadone-maintained clients are not cost-effective, but it also demonstrates that moderate amounts of support are better than minimal amounts. As funding for these programs is reduced, these findings suggest a floor below which supplementary support should not fall.     

Personality disorder subtypes among opiate addicts in methadone maintenance.

The Millon Clinical Multiaxial Inventory was administered to 196 men and 113 women newly admitted to methadone maintenance. The distribution of participants among Axis I subtypes was no elevation (18.8%), drug-alcohol abuse only (25.2%), affective disturbance (31.7%), and psychotic symptoms(l7.2%); among Axis II subtypes it was no elevation (10.4%), narcissistic-antisocial (36.2%), dependent (16.2%), withdrawn-negativistic (12.6%), histrionic (7.4%), and severe personality disorder (8.4%). Women were more likely to be assigned to histrionic, dependent, and severe personality disorder subtypes. Proportionately more Black participants were assigned to drug-alcohol only, psychotic symptoms, narcissistic-antisocial, and severe personality disorder subtypes. The proportion retained in treatment at 18 mo was higher for withdrawn (.51) and histrionic (.33) than other Axis II subtypes (range?=?.13–.22). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is diurnal variation of mood associated with parasympathetic activity?

70 patients older than 50 years (mean age: 60.2 years) underwent a CD-spondylodesis from 1987 to 1991 for degenerative changes of the lumbar spine, and were followed for 2 years. 88.2% improved, but only 47.1% showed a good-to-excellent result. Patients with fair and poor outcomes had had significantly more operations on the lumbar spine (p < 0.001), had a greater extent of preoperative lumbar kyphosis (p < 0.05), motor weakness (p < 0.05), had less vertebral slips (p < 0.01), had less posterior distraction postoperatively (p < 0.001), and had a greater extent of postoperative motor weakness compared to patients with good-to-excellent outcomes. Age, sex, duration of back/leg pain, taking of analgetic drugs, preoperative pain status, profession, range of walking, time of operation, number of fused segments, blood loss, blood transfusion, postoperative profile of the spine did not show any significant influence upon clinical results. Already at 6-months-follow-up there was significant difference of the clinical outcome (p < 0.001), making improvement of a then fair or poor result unlikely.