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Biomedical subjects

J F Maddux

Publications and source records attributed to J F Maddux.

12 recordsLinked to original sources
PubMed1992

Methadone maintenance and recovery from opioid dependence.

While maintained on methadone, heroin users reduce their heroin use and related criminal activity and increase their legitimate employment. These benefits are obtained at the cost of continued opioid dependence. Furthermore, as a consequence of neural adaptation and conditioning, methadone maintenance may impede eventual recovery from opioid dependence. The authors attempt to assess such a possible effect by comparing long-term outcomes after methadone maintenance with those after drug-free treatment. In five long-term follow-up studies of methadone maintenance, the percentages found voluntarily abstinent ranged from 9 to 21. In six long-term follow-up studies of drug-free treatment, the percentages found voluntarily abstinent ranged from 10 to 19. These rates seem remarkably similar. They do not suggest that methadone maintenance impedes eventual recovery from opioid dependence, but they do not clearly exclude such an effect.

Follow-Up Studies↗
PubMed1992

Ten-year follow-up after admission to methadone maintenance.

To assess the long-term effects of methadone maintenance, we compared the 10-year outcomes of 95 chronic opioid users who spent at least one cumulative year on methadone with those of 77 chronic opioid users who spent less than one cumulative year on methadone. All subjects were men and 90% were Mexican-American. The two groups were similar on 12 of 15 background variables. During the 10-year period, the methadone group had a cumulative mean of 54 months on methadone, while the comparison group had a cumulative mean of only 2 months on methadone. On social performance, as measured by months employed and months institutionalized, the methadone group did significantly better than did the comparison group. On months of voluntary abstinence, however, the comparison group did significantly better than did the methadone group. The mean of the comparison group, 36 months, was three times greater than that, 12 months, of the methadone group. At the end of the 10-year period, 26% of the comparison group but only 7% of the methadone group had been in continuous voluntary abstinence for 3 years or longer. Methadone maintenance for 1 year or longer was inversely related to abstinence during and at the end of the 10 years. This finding seems consistent with the hypothesis that methadone maintenance for 1 year or longer impedes eventual recovery from opioid dependence. For many patients, however, the benefits of prolonged maintenance could outweigh the possible cost of diminished likelihood of eventual recovery.

Adult↗
PubMed1991

Methadone dose and urine morphine.

When methadone maintenance was introduced in 1965, daily doses of approximately 100 mg were advocated and used; later, doses under 50 mg became common; recently, doses between 50 and 100 mg have been recommended. In a historical study and a cross-section study in one program the authors found no relationship between methadone dose and urine morphine. Patients on methadone doses under 50 mg had nearly the same percentage of urine tests positive for morphine as did those on doses of 50 mg and more. Gender, ethnic background, and age were also unrelated to urine morphine. Time on methadone was inversely related to urine morphine. Patients maintained on methadone for 3 years or longer showed a marked decrease in urine tests positive for morphine. Increased urine morphine during one decade was associated with program and community changes that could have prompted increased heroin use. These findings suggest that variables other than methadone dose affect heroin use.

Adult↗
PubMed1979

Crime and treatment of heroin users.

In San Antonio serious reported crime increased every year from 1965 through 1969. Then, in 1970, coincident with a marked increase of heroin users in treatment, the crime rate decreased. In three succeeding years while the treatment rate increased, crime decreased. Then in 1974, due to loss of program funds, the treatment rate decreased and the crime rate increased. The changes in the crime rate were due primarily to changes in the theft rate. For the years 1970-1974, treatment and theft had a significant negative correlation. We tentatively attribute part of the changes in the theft rate to changes in the treatment rate.

Crime↗
PubMed1978

Street heroin potency and deaths from overdose in San Antonio.

Disagreement over the mechanism of death in so-called heroin overdose has been noted in the medical literature for more than a decade. We studied the relationship between the potency of street heroin and the frequency of heroin overdose deaths in San Antonio in order to test the "pharmacologic overdose" hypothesis. We found a small, nonsignificant correlation (r=+.13) between monthly mean heroin dose and monthly number of heroin overdose deaths over a 5-year period. This low correlation contradicts findings of previous studies in Washington, D.C. and Atlanta, conducted over shorter periods of time, in which high positive correlations were found. The low correlation does not support the pharmacologic overdose hypothesis. Since there were confounding variables, the data do not refute the hypothesis. These variables include the use of alcohol and other depressants, hidden suicide, and reduced opioid drug tolerance due to institutional treatment.

Drug Packaging↗
PubMed1978

Arrests before and during methadone maintenance.

The effect of methadone maintenance on criminal behavior remains ambiguous, in part because of major methodological problems with most studies. We attempted to approach the problem more precisely than previous studies by comparing official police arrest records of 100 heroin addicts for 1 year before admission with those for 1 year after admission. The total number of criminal charges decreased from 189 before admission to 129 after admission. Excluding vagrancy, because of a change in police arrest practice, we found only a 14% reduction in criminal charges. A statistically significant decrease of 40% occurred in one category, burglary and theft. Arrest frequencies were generally correlated with other outcome measures such as employment status and continuation in methadone treatment. The results suggest a modest reduction in criminal behavior as a result of methadone maintenance, with insignificant reduction in crime not directly related to narcotic addiction.

Adult↗
PubMed1977

Driving records before and during methadone maintenance.

We compared the motor vehicle driving records of 104 former heroin users during 1 year of heroin use before admission to methadone maintenance with their records during 1 year after admission while they were maintained on methadone. We found a statistically significant increase in convictions for speeding from the year on heroin to the year on methadone, but no significant change in convictions for negligent collision, other moving violations, driving without a license, and in accidents. The results suggest that heroin users have slightly better driving records on heroin than they do on methadone, possibly because on heroin they drive with special care to avoid arrest. The frequency with which our subjects were involved in accidents did not differ significantly from that of all Texas licensed drivers. On the basis of this study we recommend no restriction of the driving privilege of persons maintained on methadone.

Automobile Driving↗
PubMed1976

Methadone dispensing by community pharmacies.

This study reports 1 year follow-up data of 96 patients who received methadone at selected community pharmacies instead of traditional program dispensaries. Outcomes are comparable to those reported for traditional programs. Security measures were not a problem. The results indicate that most patients can begin methadone maintenance at a pharmacy without a period of stabilization at a program unit. Of several factors studied, arrest record, both preceding and during treatment, based on official police data was the single factor significantly associated with employment and continuation in methadone treatment. Community pharmacy dispensing of methadone is a useful means of operating a methadone treatment program.

Adult↗
PubMed1975

Problem drinkers among patients on methadone.

Among 212 former heroin users maintained on methadone, the authors identified 27% as problem drinkers. The problem drinkers were found remarkably similar to other patients on methadone in personal and treatment characteristics. They differed significantly from other patients in only three respects: the problem drinkers worked more frequently at manual labor, they had more evidence of liver disease, and they appeared more depressed. All subjects showed more depression than normal controls. This finding with evidence from other studies of depression among opioid users suggests that depression may serve as an important etiological factor in chronic opioid use.

Adult↗