Article

Methadone dosage and retention: An examination of the 60 mg/day threshold

Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MD 20857, USA.
Journal of Addictive Diseases (Impact Factor: 1.46). 02/2005; 24(3):23-47. DOI: 10.1300/J069v24n03_03
Source: PubMed

ABSTRACT A National Institutes of Health (NIH) expert panel has mentioned a daily methadone dose of at least 60 mg as a best practice in methadone maintenance. The focus of this research is to estimate the percentage of outpatient methadone clients receiving this level of methadone and examine the association between treatment retention and level of methadone dosage as recommended by the NIH expert panel. A sample of 428 methadone clients discharged from methadone treatment facilities from the Alcohol and Drug Services Study (ADSS) was used, representing 109,973 methadone clients nationally. It was estimated that more than two-thirds of methadone clients nationally were receiving below 60 mg/day. While controlling for a number of client and organizational variables, a daily methadone dose of 60 mg/day or above was found to be associated with longer retention in treatment. Exploring factors affecting the utilization of the recommended daily methadone dose remains an important issue in effective delivery of methadone treatment.

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    • "In Italy, low-threshold facilities for drug addicts are available in each territorial district. In those settings, when opioid agonists are employed, dosage and duration of treatment are usually limited, regardless of clinical indication (Salamina et al., 2010; Schifano et al., 2006), which suggests the value of increased dosage or treatment duration (Brady et al., 2005; D'Ippoliti et al., 1998; Faggiano et al., 2003; Pollack and D'Aunno, 2008). Patients are allowed to negotiate the lowering of dosages regardless of urinalyses , and to have their medication tapered earlier than advisable on the basis of the scientific literature. "
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    ABSTRACT: The aim of this study was to compare the long-term outcomes of treatment-resistant bipolar 1 heroin addicts with peers who were without DSM-IV axis I psychiatric comorbidity (dual diagnosis). 104 Heroin-dependent patients (TRHD), who also met criteria for treatment resistance - 41 of them with DSM-IV-R criteria for Bipolar 1 Disorder (BIP1-TRHD) and 63 without DSM-IV-R axis I psychiatric comorbidity (NDD-TRHD) - were monitored prospectively (3 years on average, min. 0.5, max. 8) along a Methadone Maintenance Treatment Programme (MMTP). The rates for survival-in-treatment were 44% for NDD-TRHD patients and 58% for BIP1-TRHD patients (p=0.062). After 3 years of treatment such rates tended to become progressively more stable. BIP1-TRHD patients showed better outcome results than NDD-TRHD patients regarding CGI severity (p<0.001) and DSM-IV GAF (p<0.001). No differences were found regarding urinalyses for morphine between groups during the observational period. Bipolar 1 patients needed a higher methadone dosage in the stabilization phase, but this difference was not statistically significant. The observational nature of the protocol, the impossibility of evaluating a follow-up in the case of the patients who dropped out, and the multiple interference caused by interindividual variability, the clinical setting and the temporary use of adjunctive medications. Contrary to expectations, treatment-resistant patients with bipolar 1 disorder psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.
    Journal of Affective Disorders 08/2013; DOI:10.1016/j.jad.2013.06.054 · 3.71 Impact Factor
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    • "In Italy, low-threshold facilities for drug addicts are available in each territorial district. In those settings, when opioid agonists are employed, dosage and duration of treatment are usually limited, regardless of clinical indication (Salamina et al., 2010; Schifano et al., 2006), which suggests the value of increased dosage or treatment duration (Brady et al., 2005; D'Ippoliti et al., 1998; Faggiano et al., 2003; Pollack and D'Aunno, 2008). Patients are allowed to negotiate the lowering of dosages regardless of urinalyses , and to have their medication tapered earlier than advisable on the basis of the scientific literature. "
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    ABSTRACT: OBJECTIVE: The aim of this study was to compare the long-term outcomes of treatment-resistant bipolar 1 heroin addicts with peers who were without DSM-IV axis I psychiatric comorbidity (dual diagnosis). METHOD: 104 Heroin-dependent patients (TRHD), who also met criteria for treatment resistance - 41 of them with DSM-IV-R criteria for Bipolar 1 Disorder (BIP1-TRHD) and 63 without DSM-IV-R axis I psychiatric comorbidity (NDD-TRHD) - were monitored prospectively (3 years on average, min. 0.5, max. 8) along a Methadone Maintenance Treatment Programme (MMTP). RESULTS: The rates for survival-in-treatment were 44% for NDD-TRHD patients and 58% for BIP1-TRHD patients (p=0.062). After 3 years of treatment such rates tended to become progressively more stable. BIP1-TRHD patients showed better outcome results than NDD-TRHD patients regarding CGI severity (p<0.001) and DSM-IV GAF (p<0.001). No differences were found regarding urinalyses for morphine between groups during the observational period. Bipolar 1 patients needed a higher methadone dosage in the stabilization phase, but this difference was not statistically significant. LIMITATIONS: The observational nature of the protocol, the impossibility of evaluating a follow-up in the case of the patients who dropped out, and the multiple interference caused by interindividual variability, the clinical setting and the temporary use of adjunctive medications. CONCLUSIONS: Contrary to expectations, treatment-resistant patients with bipolar 1 disorder psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity
    Journal of Affective Disorders 08/2013; DOI:10.1016/j.jad.2013.06.054. · 3.71 Impact Factor
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    • "Further evidence of the effectiveness of methadone treatment comes from our finding that prescribing 60 mg or more of methadone can result in a longer stay in treatment than prescribing a lower dose. This finding is consistent with a previous study of 428 methadone patients in which it was found that a daily methadone dose of 60 mg/day or above was associated with longer retention in treatment [19]. Hence, both policy makers and psychiatrists should redefine methadone treatment as a medication-assisted therapy that is aimed at, but not limited to, the reduction of HIV infection among heroin users. "
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    ABSTRACT: Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program in response to the human immunodeficiency virus (HIV), which is endemic among Taiwanese heroin users. The present study was aimed at examining the clinical and behavioral characteristics of methadone patients in northern Taiwan according to their HIV status. The study was conducted at four methadone clinics. Participants were patients who had undergone methadone treatment at the clinics and who voluntarily signed a consent form. Between August and November 2008, each participant completed a face-to-face interview that included questions on demographics, risk behavior, quality of life, and psychiatric symptoms. Data on HIV and hepatitis C virus (HCV) infections, methadone dosage, and morphine in the urine were retrieved from patient files on the clinical premises, with permission of the participants. Of 576 participants, 71 were HIV positive, and 514 had hepatitis C. There were significant differences between the HIV-positive and HIV-negative groups on source of treatment payment, HCV infection, urine test results, methadone dosage, and treatment duration. The results indicate that HIV-negative heroin users were more likely to have sexual intercourse and not use condoms during the 6 months prior to the study. A substantial percent of the sample reported anxiety (21.0%), depression (27.2%), memory loss (32.7%), attempted suicide (32.7%), and administration of psychiatric medications (16.1%). There were no significant differences between the HIV-positive and HIV-negative patients on psychiatric symptoms or quality of life. HIV-positive IDUs were comorbid with HCV, indicating the need to refer both HIV- and HCV-infected individuals for treatment in methadone clinics. Currently, there is a gap between psychiatric/psychosocial services and patient symptoms, and more integrated medical services should be provided to heroin-using populations.
    Substance Abuse Treatment Prevention and Policy 04/2011; 6(1):6. DOI:10.1186/1747-597X-6-6 · 1.16 Impact Factor
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