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At least 127 records · Page 7Linked to original sources

PubMed1995

Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone.

Buprenorphine is an opioid partial agonist being developed for possible use in the treatment of opioid dependence. In a previous study up to 8 mg of buprenorphine administered 20 hr after a daily dose of methadone in methadone-maintained volunteers produced neither agonist-like nor antagonist-like effects. The purpose of this study was to examine the effects of buprenorphine challenges given 2 hr after a daily methadone dose in maintained volunteers. Seven male volunteers maintained on 30 mg of methadone daily underwent pharmacologic challenges two to three times per week. Medication challenges consisted of double-blind i.m. injections of buprenorphine (0.5-8.0 mg), the opioid antagonist naloxone (0.1 and 0.2 mg), the prototypic opioid mu agonist hydromorphone (5 and 10 mg) or saline. Assessments of physiologic measures, volunteers' self-reports and observer ratings of drug effects were collected in a laboratory session for 2 hr after drug administration, and then for 8 additional hr postsession. Results from the laboratory session showed that on subject and observer ratings naloxone produced typical antagonist-like effects, hydromorphone produced mild agonist-like effects and buprenorphine produced antagonist-like effects. Interestingly, buprenorphine's antagonist activity was not directly dose-related; its most prominent antagonist effects occurred at the 1- and 2-mg doses. These results are consistent with buprenorphine's action as a partial mu opioid agonist and demonstrate that antagonist-like effects can occur under some conditions suggesting buprenorphine should have a low abuse liability in methadone-maintained patients.

Adult↗

PubMedDate not supplied

Hypogonadism and methadone: Hypothalamic hypogonadism after long-term use of high-dose methadone.

OBJECTIVE: To assess the relationship between hypogonadism and long-term administration of high-dose methadone. METHODS: We present a case of a 47-year-old man with a history of heroin use and treatment with high doses of methadone (130 mg/day), who complained of gynecomastia and impotence. Baseline levels of serum luteinizing hormone (LH), serum follicle-stimulating hormone (FSH), plasma testosterone, and prolactin were determined, and then the response of gonadotropin levels to stimulation with gonadotropin-releasing hormone (GnRH) was examined at 30, 60, 90, 120, and 180 minutes. RESULTS: Basal values of testosterone, LH, and FSH were below normal levels, whereas prolactin was normal. After administration of GnRH, the patient had a suboptimal increase in LH levels and lack of a response of FSH. When the daily dose of methadone was decreased to 40 mg, the patient's libido returned, and LH, FSH, and testosterone levels increased. CONCLUSION: These findings could indicate the presence of (1) a direct effect of methadone on the hypothalamus that leads to an alteration in normal gonadotropin pulse patterns, or (2) a selective effect of methadone on the anterior pituitary that alters its response to GnRH, with either mechanism leading to a reversible, dose-related depression of testosterone levels.

Journal Article↗

PubMed2001

Reinforcement by orally delivered methadone, cocaine, and methadone-cocaine combinations in rhesus monkeys: are the combinations better reinforcers?

RATIONALE: Polydrug abuse is a problem that has been infrequently examined. In the present study, drug self-administration procedures were used to investigate the reinforcing effects of drug combinations. OBJECTIVES: To determine the absolute and relative response rates maintained by orally delivered methadone, cocaine, and their combinations under sequential and concurrent access. Choice between drug combinations containing different concentrations of cocaine was also determined. METHODS: Oral intake of methadone, cocaine, and their combinations was studied with rhesus monkeys during daily 3-h sessions. Lip contact (the operant response) was reinforced by delivery of liquid contingent upon completion of a fixed-ratio schedule. In one series, the drugs and drug combinations were studied sequentially with the water vehicle concurrently available. In the next series, the drugs and drug combinations were concurrently available. In the third series, pairs of drug combinations containing different concentrations of cocaine were also concurrently available. RESULTS: Methadone, cocaine and their combinations functioned as reinforcers. Under sequential access, response rates for the drug combinations and the component drugs were often similar. However, under concurrent access, response rates for the drug combinations were greater than response rates for the component drugs at the highest FR size for each condition. Also, drug combinations containing higher cocaine concentrations were preferred to combinations containing lower cocaine concentrations. CONCLUSIONS: Combinations of methadone and cocaine have relatively greater reinforcing effects than the component drugs, and these greater reinforcing effects are better detected with concurrent measures than with sequential measures.

Administration, Oral↗

PubMed1978

Assessment of the EMIT-(TM) technique as a screening test for opiates and methadone for a methadone maintenance clinic and its calibration by Bayesian statistics.

1. The performance of the semi-quantitative enzyme multiplied immunoassay technique (EMIT, Syva Corp.) for opiates and methadone has been examined as a screening procedure of urine samples from a methadone maintenance programme. The predictive value model that is based upon Bayesian statistics was used to determine screening levels for the EMIT assays. 2. With a predictive value of a negative result of 100%, the EMIT opiate assay can be used to show the absence of the indicated drugs, while positive results can be confirmed by a non-immunological technique. A screening level of 1.0 micrograms/ml for the opiate assay, conforms to this model. 3. The EMIT methadone assay was shown to have a predictive value of a negative result of 28% with respect to thin-layer chromatographic (TLC) results. This discrepancy between EMIT and TLC can not be explained by sensitivity alone. The manufacturer's recommended 0.5 micrograms/ml cutoff has been used therefore for the methadone assay.

Chromatography, Thin Layer↗

PubMed2006

High methadone dose significantly reduces cocaine use in methadone maintenance treatment (MMT) patients.

AIM: To evaluate whether effective methadone treatment affects cocaine use. METHODS: 421 consecutive patients admitted to a methadone maintenance clinic in Israel (1993-2002) were prospectively studied. Patients' urine samples were analyzed for cocaine during months 1 and 13. RESULTS: On admission 55(13.1%) of 421 patients had urine positive for cocaine and 366 had negative. Of the 55 cocaine-positive patients, 45(81.8%) stayed in treatment at least one year, as did 267(73%) of cocaine-negative. After one year (n=312) 31 of 45 cocaine users stopped and 25 of 267 started. Methadone dose was highest in 31 patients who stopped cocaine (176.1+/-42.1 mg/ day), followed by 14 who did not stop (161.4+/-37.5 mg/day), and 25 who started during treatment (122.9+/-48.7 mg/day), or 242 who never used cocaine (119.5+/-48.4 mg/day) (ANOVA, F=15.6, p<0.0005). CONCLUSIONS: High methadone dose may reduce cocaine use in patients addicted to both heroin and cocaine.

Adolescent↗

PubMed1976

From heroin to methadone-social role changes and reinforcement differentials in relation to outcome on methadone. Part II. The study of social role changes.

The life-styles of addicts who are Successful, Marginally Successful, and Failures in a methadone maintenance program are examined by in-depth interviews in five time periods-early family life, the preheroin period, late heroin, premethadone, and methadone maintenance. The hypothesis is confirmed that the more the methadone patient has managed to develop a new and more conventional set of peer group, familial, and occupational roles, the greater the likelihood of his success on methadone maintenance. The in-depth view of the groups over time suggests that the pattern of alternation of positive reinforcements and punishing situations may be associated with outcome.

Employment↗

PubMed1978

Diversion of methadone: illicit methadone use among applicants to two metropolitan drug abuse programs.

Newly admitted patients from two comprehensive drug abuse programs in the Baltimore area were queried concerning frequency of illicit methadone use and availability of illicit methadone for a 3-month period prior to their admission. The results showed that a significant percentage of applicants had used illicit methadone prior to seeking treatment, and that for the most part they were using "program methadone" presumably diverted from take-home medication from patients active in treatment programs in the Maryland area. The clinical and rehabilitative aspects of take-home medication are carefully assessed in relation to these somewhat disturbing findings.

Costs and Cost Analysis↗

PubMed1997

Abstinence fear in methadone maintenance withdrawal: a possible obstacle for getting off methadone.

The present study attempts to shed light on methadone maintenance patients expectations regarding withdrawal symptoms during voluntary methadone detoxification. The study includes two groups of subjects; one group who have tried on their own initiative to terminate their methadone maintenance treatment (Group 1) and one group that contains rehabilitated patients who have not tried to quit using methadone (Group 2). Two main results have emerged. Group 1 has negative expectations beforehand about the intensity of withdrawal which significantly exceed the later, actual experience. Group 2 has negative expectations about the intensity of withdrawal that significantly exceed the negative expectations of Group 1. The clinical implications of these results are discussed.

Adult↗

PubMed1994

Methadone anonymous: a 12-step program. Reducing the stigma of methadone use.

1. Methadone is a synthetic narcotic that relieves the craving for heroin. Methadone enables the former heroin addict to feel well and unimpaired by side effects, and be free of heroin hunger. 2. Methadone Anonymous (MA) is a 12-step program (similar to Alcoholics Anonymous and Narcotics Anonymous) for individuals with addictions who are in methadone treatment programs. 3. The MA program at our facility in New York has been extremely successful. Patients carry the message to new sites and leave information for potential groups. Requests for information are received weekly, both from neighboring states and even abroad.

Adult↗

PubMed1997

The relationship of methadone dose and other variables to outcomes of methadone maintenance.

The authors evaluated the relationship of methadone dose to retention in treatment and to urine tests for morphine and cocaine in a cohort of 610 opioid users admitted to methadone maintenance and followed for 1 year. Methadone dosing was flexible, with patient participation in dose decisions. The maximum dose during treatment ranged from 10 mg to 110 mg, with a mean of 52 mg. Higher doses were associated with increased retention through the dose range of 60 mg-69 mg. Dose was not related to the likelihood of a positive morphine test but was related to the likelihood of a positive cocaine test. In this study, with flexible dosing and patient participation in dose decisions, patients were retained on methadone about as well as was reported in a previous study with patients on a fixed dose of 80 mg.

Adult↗

PubMed1996

"Non injectables": methadone syrup and benzodiazepine injection by methadone-maintained clients.

To obtain more information about anecdotal reports of injection of methadone syrup and benzodiazepine drugs among injecting drug users, interviews were conducted with 32 subjects as part of a larger study into drug use patterns of clients in methadone maintenance treatment. Subjects were asked about frequency of injection of methadone and benzodiazepines, reasons for injection and methods of preparation for injection. The study found that 78% had injected methadone and 25% had injected benzodiazepines at some time during their drug using careers. Service providers can play an important role in promoting harm minimization strategies, and utilizing behaviour modification techniques.

Journal Article↗

PubMed2005

Health problems and help-seeking activities of methadone maintenance clients at Auckland Methadone Service (AMS): potential for community pharmacy service expansion?

BACKGROUND: In general the health of methadone clients has been found to be poorer than that of the general population. In New Zealand specialist drug services are not funded to provide primary healthcare services. Many health conditions could potentially be managed by community pharmacists who have frequent contact with this client group. This study sought to explore the health problems suffered by methadone clients, who they sought help from, and the potential for greater involvement of pharmacists. METHODS: Self-completion questionnaire of methadone maintenance clients managed in specialist care in Auckland, New Zealand. RESULTS: The most common health problem experienced by these clients in the past three months was sweating (70.0%), and more than half of the respondents also reported experiencing headache, fatigue and depression. The least frequently experienced conditions were hay fever (12.9%) and abscesses (12.1%). Respondents indicated that the top three choices from whom they would seek help were GP (56.7%), the client's partner (31.6%) and community pharmacists (27.9%). Barriers to seeking help from pharmacists included issues around cost, perceptions of pharmacist knowledge and skills, privacy and confidentiality. CONCLUSION: Methadone clients in this study indicated that they suffered a number of general health problems, and in many cases were likely to seek help from a GP or their own partner, before seeking help from pharmacists. However, for over one quarter of respondents the pharmacist was in the top three from whom they would seek advice. Any barriers towards consulting pharmacists, in the main seem to be resolvable.

Journal Article↗

PubMed1983

Pharmacokinetics of methadone in methadone maintenance treatment: characterization of therapeutic failures.

Deuterated methadone (M-d3) and GC-MS analysis were used to study the steady state pharmacokinetics of methadone (M) in eight patients reported as therapeutic failures in a methadone maintenance treatment programme. The patients were compared to an unselected group of 12 patients stabilized on M for 25 days. During one dosage interval a pulse dose of M-d3 was administered intravenously instead of the oral M-dose (M-d0). The pharmacokinetic parameters, half-life in the beta-phase (t1/2 beta), volume of distribution during the postdistributive phase (Vd beta) and during steady state (Vdss) were determined as well as the body (ClS) and renal (ClR) clearances of M. Pronounced differences in Vd beta and Vdss were found between the two groups. The therapeutic failures had a smaller Vd beta and Vdss 3.09 +/- 0.96 1/kg and 2.74 +/- 0.96 1/kg vs 4.56 +/- 1.00 1/kg and 4.20 +/- 0.78 1/kg in the control group. The differences were due to changes between the groups in the volume of the central compartment. Differences between the groups were also found in t1/2 beta - 24.5 +/- 2.6 h in the therapeutic failures and 34.0 +/- 7.0 h (p less than 0.001) in the comparison group. However, the change in t1/2 beta was probably a consequence of the change in Vd beta, as the body clearance of M was similar in the two groups - 104 +/- 36 ml/min vs 111 +/- 36 ml/min. The smaller volume of distribution could lead to unacceptably high fluctuation of M in the central compartment, and withdrawal symptoms during the latter part of the dosage interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Effect of methadone dose contingencies on urinalysis test results of polydrug-abusing methadone-maintenance patients.

Drug abuse outcomes were examined during 2 contingency management procedures in which the size of the methadone dose was determined by recent urinalysis test results. Twenty polydrug-abusing methadone-maintenance patients were exposed to one of two specific altered dose consequences: a positive incentive procedure in which dose could only increase above baseline levels as a result of drug-free urines and a negative incentive procedure in which dose could only decrease below original baseline levels as a result of drug-positive urines. About 13% of urinalysis test results were drug-free during a 10-week pre-study baseline period while about 40-50% of urines were drug-free for both treatment groups during an 18-week intervention period. About half of the subjects in each study condition showed marked improvement during the intervention, while the other half failed to improve their urine test results. Treatment failures in the dose decrease as compared with the dose increase condition were more likely to drop out of the study. The study showed that size of the methadone dose can be effectively used as a consequence to influence illicit drug use during treatment. The study suggests that positive reinforcement as compared with aversive control procedures can produce an equivalent number of successful cases while avoiding dropout among patients who fail to respond to treatment.

Adult↗

PubMed1982

Lack of effect of diazepam on methadone metabolism in methadone-maintained addicts.

Four methadone-maintained subjects were given diazepam (0.3 mg/kg) for 9 days. During the dual drug period, the effects and kinetics of methadone and of its major pyrrolidine metabolite were not altered. These findings indicate that, unlike its effects in rodents, diazepam does not inhibit the metabolism of methadone in man.

Adult↗

PubMed2004

[Intoxication with methadone and benzodiazepines in a morbidly obese patient in the social environment of a heroin addict receiving methadone maintenance therapy].

Methadone is a well-established maintenance drug for the therapy of opioid addicts. Reduction of mortality, social stabilization and reintegration are basic goals of this therapeutic concept. In the ideal case, total opioid abstinence can be achieved. In Germany, detailed guidelines exist for methadone maintenance treatment (e. g. choice of the maintenance drug, "take home" doses) and are regularly published and updated by the National Medical Council. In the social environment of opioid addicts, misuse or accidental intoxication in non-addict family members or co-addicts may occur. We report an intoxication with methadone of the husband of a heroin-addict patient. In this morbidly obese patient, a simultaneous ingestion of benzodiazepines was suspected. This case report describes the diagnostic and therapeutical options of an opioid intoxication in a patient with severe obesity with special emphasis on the airway management strategy in an out-of-hospital situation.

Analgesics, Opioid↗

PubMed1976

Rapid screening and confirmation of amphetamine, methamphetamine, methadone, and methadone metabolite in urine by gas/thin layer chromatography.

A method suitable for large scale screening and confirmation of urine speciments for amphetamine, methamphetamine, methadone, and its primary metabolite (2-ethylidene-1,5-dimethyl-3,3-diphenlypyrrolidine) is described. The drugs are extracted from alkaline urine into an organic solvent. The amphetamine drugs are then back-extracted into a small volume of acid and identified by gas chromatography both as free bases on a 10% Apiezon L-10% KOH column and as their trifluoracetamide derivatives on a 3% OV-17 column. The organic layer, which still contains methadone and its primary metabolite, is analyzed by split-sample thin-layer chromatography using two solvent systems: ethyl acetate: methylene cloride: concentrated ammonium hydroxide (90:10:0.7) and methanol: chloroform: concentrated ammonium hydroxide (74:25:0.8). These solvent systems separate methadone from its primary metabolite without interference from other drugs or urinary substances.

Amphetamine↗

PubMed2002

Optimizing long-term response to methadone maintenance treatment: a 152-week follow-up using higher-dose methadone.

We report the clinical course over 152 weeks of 245 patients in methadone maintenance treatment: 144 high dose (HD) patients (> or = 100 mg/d, mean 211 mg/d), and 101 control (C) patients (< 100 mg/d, mean 65 mg/d). After 152 weeks the mean methadone doses were 284.9 mg/d (range 13-1100 mg/d) and 94.0 mg/d (range 10-500 mg/d), respectively. Overall retention in treatment was 59% over the 152 weeks, with the HD group having significantly better retention (61.1% vs. 46.3%) and lower rates of positive urine toxicologies (16.0% vs. 36.6%). Mortality was statistically the same for the HD group (2/144, 1.4%) and the C group (2/101, 1.9%) over the 152-week period. We conclude that doses of methadone exceeding 100 mg/d are safe and effective in long-term maintenance treatment. We attribute the favorable outcomes we report to a model of treatment that emphasizes medication management in the treatment of opioid addiction.

Adult↗