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PloS One May 2011Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in...
Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in dose requirement and clinical outcome remains controversial. The aim of this study is to analyze methadone dosage in responder and nonresponder patients considering pharmacogenetic and pharmacokinetic factors that may contribute to dosage adequacy. Opioid dependence patients (meeting Diagnostic and Statistical Manual of Mental Disorders, [4(th) Edition] criteria) from a MMT community program were recruited. Patients were clinically assessed and blood samples were obtained to determine plasma concentrations of (R,S)-, (R) and (S)-methadone and to study allelic variants of genes encoding CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19, and P-glycoprotein. Responders and nonresponders were defined by illicit opioid consumption detected in random urinalysis. The final sample consisted in 105 opioid dependent patients of Caucasian origin. Responder patients received higher doses of methadone and have been included into treatment for a longer period. No differences were found in terms of genotype frequencies between groups. Only CYP2D6 metabolizing phenotype differences were found in outcome status, methadone dose requirements, and plasma concentrations, being higher in the ultrarapid metabolizers. No other differences were found between phenotype and responder status, methadone dose requirements, neither in methadone plasma concentrations. Pharmacokinetic factors could explain some but not all differences in MMT outcome and methadone dose requirements.
Topics: ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Adult; Alleles; Cytochrome P-450 Enzyme System; Dose-Response Relationship, Drug; Female; Humans; Male; Methadone; Middle Aged; Opioid-Related Disorders
PubMed: 21589866
DOI: 10.1371/journal.pone.0019527 -
The American Journal of Drug and... Nov 2012To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer.
OBJECTIVES
To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer.
METHODS
We analyzed a database of all patient clinic visits, laboratory tests for urine toxicology screening, and methadone scripts from a group of methadone clinics in Ontario. The database consisted of patient visits and visit information from 1 January 2003 to 31 December 2009. We estimated the cost of providing methadone maintenance treatment as the sum of physician costs, laboratory costs for urine samples (toxicology screens), methadone costs, and pharmacy costs. Pharmacy costs include dispensing fees and markups. All costs are expressed in 2010 Canadian dollars.
RESULTS
The database consisted of 9479 unique patients. The average age on the date of the first recorded visit was 34.3, and among the patients 62.3% were male. There were 6,425,937 patient days of treatment and the total cost of all treatment-related services was approximately $99,491,000. The total cost was comprised of physician billing (9.8%), pharmacy costs (39.8%), methadone (3.8%), and performing urine toxicology screens (46.7%). The average cost per day for treatment was $15.48, corresponding to $5651per year if patients were to remain in treatment continuously.
CONCLUSIONS
The cost of providing methadone maintenance treatment in Ontario is comparable to estimates from the United States and Australia.
SCIENTIFIC SIGNIFICANCE
This information is important to policy makers for planning and budgeting purposes and as part of a full cost-benefit or cost-effectiveness analysis of methadone treatment.
Topics: Adult; Cost-Benefit Analysis; Databases, Factual; Drug Costs; Female; Health Care Costs; Humans; Male; Methadone; Ontario; Opiate Substitution Treatment; Opioid-Related Disorders; Substance Abuse Detection
PubMed: 22783917
DOI: 10.3109/00952990.2012.694518 -
The Canadian Journal of Nursing... Mar 2022Opioid use has escalated dramatically resulting in an increase in deaths. Access to treatment for opioid use disorder (OUD) is poor. The addition of nurse practitioners...
BACKGROUND
Opioid use has escalated dramatically resulting in an increase in deaths. Access to treatment for opioid use disorder (OUD) is poor. The addition of nurse practitioners (NPs) as prescribers of methadone for OUD offers potential for improving access. Little is known about what support NPs will require as they prescribe methadone.
PURPOSE
This paper identifies facilitators and barriers to NPs prescribing methadone.
METHODS
In this qualitative study, in-person and phone semi-structured interviews were conducted with 18 participants. Participants included NPs (n=5), physicians (n=5), and stakeholders including members of professional regulatory bodies and government, academics and other clinicians (n=8). Interviews were recorded, transcribed, and analyzed using thematic analysis and software (NVivo 12.4.0) for data management.
RESULTS
Four themes emerged: 1) Pervasive Barrier of Stigma; 2) Perceived Complexity of Patients Living with OUD; 3) NP Education and Practice Supports and; 4) Health Care Context and NP Role Implementation.
CONCLUSIONS
Barriers and facilitators to NP prescribing are similar to those encountered by physicians. Factors unique to NPs include the identification of role clarity as a facilitator and navigation of physician networks as a barrier. Research conducted with current NP methadone prescribers is required to evaluate implementation of this service.
Topics: Humans; Methadone; Nova Scotia; Nurse Practitioners; Opiate Substitution Treatment; Opioid-Related Disorders
PubMed: 33615847
DOI: 10.1177/0844562121996222 -
Molecules (Basel, Switzerland) Jun 2023Insects on corpses could be a useful tool for the detection of exogenous substances such as drugs of abuse. The identification of exogenous substances in carrion insects...
Detection of Three Opioids (Morphine, Codeine and Methadone) and Their Metabolites (6-Monoacetylmorphine and 2-Ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine) in Larvae of Species by UHPLC-TF-MS and Validation.
Insects on corpses could be a useful tool for the detection of exogenous substances such as drugs of abuse. The identification of exogenous substances in carrion insects is critical for proper estimation of the postmortem interval. It also provides information about the deceased person that may prove useful for forensic purposes. High-performance liquid chromatography coupled with Fourier transform mass spectrometry is a highly sensitive analytical technique that can identify substances even at very low concentrations, such as in the case of searching for exogenous substances in larvae. In this paper, a method is proposed for the identification of morphine, codeine, methadone, 6-monoacetylmorphine (6-MAM) and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in the larvae of , a common carrion fly widely distributed in temperate areas of the world. The larvae, which were reared on a pig meat substrate, were killed once they reached their third stage by immersion in hot water at 80 °C and aliquoted into 400 mg samples. The samples were fortified with 5 ng of morphine, methadone and codeine. After solid-phase extraction, the samples were processed with a liquid chromatograph coupled to a Fourier transform mass spectrometer. This qualitative method has been validated and tested on larvae from a real case. The results lead to the correct identification of morphine, codeine, methadone and their metabolites. This method could prove useful in cases where toxicological analysis must be conducted on highly decomposed human remains, where biological matrices are very limited. Furthermore, it could help the forensic pathologist to better estimate the time of death, as the growth cycle of carrion insects can undergo changes if exogenous substances are taken.
Topics: Animals; Humans; Methadone; Analgesics, Opioid; Codeine; Morphine; Larva; Chromatography, High Pressure Liquid; Morphine Derivatives; Diptera
PubMed: 37375203
DOI: 10.3390/molecules28124649 -
Anesthesiology May 2015
Topics: Analgesics, Opioid; Female; Humans; Male; Methadone; Pain, Postoperative
PubMed: 25768861
DOI: 10.1097/ALN.0000000000000634 -
Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial).PloS One 2017Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment.
METHODS
This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model.
RESULTS
The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference.
CONCLUSIONS
Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.
Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Female; Humans; Inappropriate Prescribing; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Pain; Suicide Prevention
PubMed: 28520735
DOI: 10.1371/journal.pone.0176288 -
Addiction Science & Clinical Practice May 2024Delivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in...
BACKGROUND
Delivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in rural mountainous areas. This study aims to investigate factors related to confidence in providing methadone treatment among primary care providers in Vietnam to inform good practice development.
METHODS
We conducted a cross-sectional survey with 276 primary care providers who were physicians, physician assistants, nurses, pharmacists or dispensing staff from 67 communes in a mountainous province in Northern Vietnam. Using self-report scales, we measured providers' confidence in providing methadone treatment, beliefs in harm reduction, perceived work-related support, perceived stigma and risk in working with drug-using patients, and empathy towards this population. We used multiple linear regression analyses to explore factors associated with providers' confidence in providing methadone treatment in the whole sample and to compare two groups of providers who did and did not have experience providing methadone. Potential associated factors were measured at facility and provider levels.
RESULT
114 (41.3%) participants had previously experience in providing methadone treatment. Providers with methadone treatment experiences had higher confidence in and more accurate knowledge of methadone treatment, perceived less stigma of working with drug-using patients, and reported more work-related support than those without experiences. Higher medical education is associated with lower confidence in providing methadone treatment among providers without methadone experiences, but higher confidence among providers with methadone experiences. Better methadone knowledge was associated with greater confidence in providing methadone treatment among inexperienced providers but not among those with experiences. Receiving work-related support was associated with greater confidence in providing treatment in both groups, regardless of their past methadone experiences.
CONCLUSION
In rural provinces where methadone treatment has been expanded to primary care clinics, interventions to improve primary care providers' confidence should benefit professionals with diverse experiences in providing methadone treatment. Continued training and support at work for providers is essential to ensuring quality in decentralized methadone treatment.
Topics: Humans; Methadone; Vietnam; Cross-Sectional Studies; Female; Male; Primary Health Care; Opiate Substitution Treatment; Adult; Attitude of Health Personnel; Middle Aged; Health Personnel; Opioid-Related Disorders; Social Stigma; Harm Reduction; Health Knowledge, Attitudes, Practice
PubMed: 38778428
DOI: 10.1186/s13722-023-00419-5 -
Addiction Science & Clinical Practice Jun 2021Patients with opioid use disorder (OUD) often have complex health care needs. Methadone is one of the medications for opioid use disorder (MOUD) used in the management...
BACKGROUND
Patients with opioid use disorder (OUD) often have complex health care needs. Methadone is one of the medications for opioid use disorder (MOUD) used in the management of OUDs. Highly restrictive methadone treatment-which requires patient compliance with many rules of care-often results in low retention, especially if there is inadequate support from healthcare providers (HCPs). Nevertheless, HCPs should strive to offer patient-centred care (PCC) as it is deemed the gold standard to care. Such an approach can encourage patients to be actively involved in their care, ultimately increasing retention and yielding positive treatment outcomes.
METHODS
In this secondary analysis, we aimed to explore how HCPs were applying the principles of PCC when caring for patients with OUD in a highly restrictive, biomedical and paternalistic setting. We applied Mead and Bower's PCC framework in the secondary analysis of 40 in-depth, semi-structured interviews with both HCPs and patients.
RESULTS
We present how PCC's concepts of; (a) biopsychosocial perspective; (b) patient as a person; (c) sharing power and responsibility; (d) therapeutic alliance and (e) doctor as a person-are applied in a methadone treatment program. We identified both opportunities and barriers to providing PCC in these settings.
CONCLUSION
In a highly restrictive methadone treatment program, full implementation of PCC is not possible. However, implementation of some aspects of PCC are possible to improve patient empowerment and engagement with care, possibly leading to increase in retention and better treatment outcomes.
Topics: Buprenorphine; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Patient-Centered Care
PubMed: 34187549
DOI: 10.1186/s13722-021-00251-9 -
The International Journal on Drug Policy Jun 2022Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this...
BACKGROUND
Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this region that offers methadone within prisons, but uptake and post-release retention remains suboptimal. Screening, brief intervention, and referral to treatment (SBIRT) procedures are a potential implementation strategy to address this problem.
METHODS
From June 1, 2017 to March 3, 2018, we conducted a 2-stage SBIRT strategy in nine prisons and four pre-trial detention facilities in Moldova among incarcerated persons with opioid use disorder (OUD; N = 121) and within 90 days of release. Survey results were analyzed to evaluate the effect of the SBIRT strategy on the uptake of and post-release retention on methadone maintenance treatment (MMT).
RESULTS
Among the 121 screened with OUD, 27 were on MMT at baseline within the prison and this number increased to 41 after the two-step SBIRT intervention, reflecting a 51.9% increase over baseline. Eleven (78.6%) of the 14 participants that newly started MMT did so only after completing both SBIRT sessions. The brief intervention did not significantly improve knowledge about methadone but did improve attitudes towards it. Among the 41 participants who received methadone during this trial, 40 (97.6%) were retained 6 months after release; the one participant not retained was on methadone at the time of the intervention and had planned to taper off.
CONCLUSION
The SBIRT strategy significantly improved participant attitudes, but treatment initiation mostly occurred after completing both sessions, including soon after release, but remained low overall. Work within the Moldovan prison subculture to dispel negative myths and misinformation is needed to further scale-up OAT in Moldova.
Topics: Humans; Methadone; Moldova; Opiate Substitution Treatment; Opioid-Related Disorders; Prisoners
PubMed: 35417790
DOI: 10.1016/j.drugpo.2022.103683 -
Addiction Science & Clinical Practice Aug 2023Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in...
BACKGROUND
Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients' perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis.
METHODS
Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes.
RESULTS
Seventeen participants completed the interview. Patients' perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists' training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD.
CONCLUSION
This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients' views and needs.
Topics: Humans; Pharmacies; Opiate Substitution Treatment; Opioid-Related Disorders; Methadone; Analgesics, Opioid; Qualitative Research
PubMed: 37533071
DOI: 10.1186/s13722-023-00399-6