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

This study examines the relevance of reinforcements available to the addict in five critical stages of his career to his success on methadone maintenance. In-depth focused interviews were held with 30 addicts who had completed a program of methadone induction and who were characterized by social worker's evaluations as Successful, Marginally Adjusted, or Failures. The Successful group showed a higher initial negative reinforcement followed by higher positive reinforcement on methadone. The Moderately Successful group showed more negative reinforcement before treatment but continued to show negative reinforcements afterwards. The Failures were low on negative reinforcements earlier but negative reinforcements were high after treatment.

Adult↗

Methadone Anonymous: A 12-Step Program for Methadone Maintained Heroin Addicts.

Methadone Anonymous (MA) is a new 12-step fellowship developed for methadone maintained heroin addicts. A total of 53 MA members completed a survey assessing factors related to methadone maintenance treatment program (MMTP) entry, drug use, MA participation, beliefs concerning effectiveness of MMTP and MA, and level of social cohesiveness. Length of time in MA was associated with a decreased use of alcohol, cocaine, and marijuana. Clients rated components of MA to be significantly more helpful to recovery than MMTP treatment components. Affiliation to five MA members known best by the respondents was significantly greater than affiliation to non-MA members. Length of time in MA was positively associated with MA affiliation. Social affiliation and endorsement of 12-step principles were positively correlated. These findings suggest that MA participation has benefits not available in professionally driven MMTP, and should be further studied.

Journal Article↗

Methadone dosages and therapeutic compliance during a methadone maintenance program.

In 97 heroin addicts in a methadone maintenance treatment program (MMTP) with social services, urine screening for opioid metabolites identified groups with different treatment compliance. The positive correlation between compliance and methadone dosage confirms that MMTPs are effective in rehabilitating patients when 'adequate' dosage, i.e., capable of preventing relapse, is used.

Adolescent↗

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

The aim of this study was to identify predictors of treatment failure in a methadone maintenance treatment programme in Geneva. All patients (n = 149) starting treatment between May 1993 and May 1995 were followed until end of treatment or 31st July 1996. The proportion of depressed patients decreased significantly over time, as did the proportion of those injecting illegal drugs. The overall treatment failure was 21%. The probability of treatment failure was higher for women than for men (RR 2.2, P = 0.03) and decreased in successive cohorts. There was no correlation between the methadone dose at 2 months and treatment outcome, probably because doses were individualised and the associated level of psycho-social services high.

Adult↗

The use of serum methadone levels in patients receiving methadone maintenance.

Trough serum methadone concentration was measured in 43 patients under treatment for heroin addiction and complaining of withdrawal symptoms. Low serum levels were noted only in patients taking very low doses and in 10 patients who were concomitantly using enzyme-inducing drugs. The 27 patients in the maintenance program who had trough levels greater than 100 ng/ml were given no dose increase and were followed up prospectively. Alternate explanations for the patient's symptoms were well accepted in almost all cases, and subsequent performance in the treatment program appeared to be independent of serum level. We conclude that a trough serum level of 100 ng/ml is adequate for effective methadone maintenance. Measurement of serum levels can be a valuable intervention in patients with difficulties.

Dose-Response Relationship, Drug↗

[Treatment of drug dependent patients with methadone. 1: Goals, types and results of methadone programs].

Is the medical prescription of narcotics an adequate way to treat opiate addiction? This question has been controversial in Germany for the last two decades. In 1987, a clinical trial of levomethadone treatment has been started in North-Rhine-Westfalia. Recently, aspects of public health have come to the fore, as methadone programs are hopefully believed to contribute to the prevention of HIV-infections among intravenous drug users. Principles and models of methadone treatment are briefly discussed, international experiences reported, and major objections reviewed.

Europe↗

Stereospecific antibodies to methadone. II. Synthesis of d- and 1-methadone antigens.

Diastereomeric methadols were prepared by reduction of the methadone enantiomers. Resulting methadols, after purification and characterization by mass spectrometry, were succinylated. The hemisuccinyl derivatives were conjugated with thyroglobulin via carbodiimide condensation. The conjugates of d- and of 1-methadol hemisuccinyl-thyroglobulin were employed as the antigens for immunization of white New Zealand rabbits in order to obtain specific anti d- and anti 1-methadone antisera.

Animals↗

Selective antibodies to methadone enantiomers: synthesis of (R)- and (R,S)-methadone conjugates and determination by an immunoenzymatic method in human serum.

Selective antibodies to (R)-methadone (Mtd) and to its racemate were produced in rabbits by immunization with conjugates of (R)- or (R,S)-hemisuccinyl-methadol-bovine serum albumin, respectively. A hapten was first prepared by reduction of (R)- or (R,S)-Mtd with sodium borohydride, followed by esterification with succinic anhydride. The conjugation of hapten with albumin was achieved by the mixed anhydride method. After immunization of rabbits, the titers and specificity of each antibody were determined by ELISA. The antibodies obtained were tested with (R)-, (S)-, (R,S)-Mtd, its major metabolite (EDDP), and some drugs of abuse (morphine, codeine, cocaine). The sensitivities of antibodies to (R)- and (R,S)-Mtd were about 1 and 2 ng/ml, respectively. Selective (R)-antibodies recognized (R)-Mtd about 40 times more avidly than the (S)-isomer, while an antiserum against (R,S)-Mtd recognized (R)- and (S)-isomers to about the same degree. Both selective antibodies showed little interference (about 0.5%) with EDDP metabolite and no crossreactivity with morphine, codeine, and cocaine. These two selective antibodies were used to develop an immunoenzymatic method (ELISA) for the determination of (R)- and (R,S)-Mtd in serum samples of patients under maintenance treatment for narcotic addiction.

Animals↗

Geographical differences in risk-taking among Sydney methadone maintenance patients: a comparison of inner city and outer south western methadone maintenance patients.

The study compared the demographic profiles, treatment factors, current drug use, injecting behaviour and psychological functioning of inner city (ICS) and south-west Sydney (SWS) methadone patients. A total of 104 patients from two clinics in the inner city, and 118 patients from two clinics in the outer south-western suburbs of Sydney were interviewed using a structured interview. SWS patients were more likely to be married or de facto, to have a regular sexual partner who was an injecting drug user, and to have children in their care. While they were no more likely to have recently injected, SWS patients were twice as likely to have recently shared a needle. While SWS patients were more likely to have had sex in the month preceding interview, ICS patients were more likely to have had more than one partner in that period. Patients from the south-western clinics were twice as likely to receive a diagnosis of antisocial personality disorder, and had poorer social functioning. The clinical implications of these differences are discussed.

Journal Article↗