The New York Policy on Smoking in Addiction Treatment: Findings After 1 Year.

Filed under: Methadone Side Effects

Am J Public Health. 2012 Mar 15;
Guydish J, Tajima B, Kulaga A, Zavala R, Brown LS, Bostrom A, Ziedonis D, Chan M

Objectives. We assessed changes in smoking prevalence and other measures associated with the July 2008 New York Office of Alcohol and Substance Abuse Services tobacco policy, which required that all publicly funded addiction treatment programs implement smoke-free grounds, have “no evidence” of smoking among staff, and make tobacco dependence treatment available for all clients. Methods. In a random sample of 10 programs, staff and clients were surveyed before the policy and 1 year later. Measures included tobacco-related knowledge, attitudes, and practices used by counselors and received by clients. Results. Client smoking decreased from 69.4% to 62.8% (P?=?.044). However, response to the policy differed by program type. Outpatient programs showed no significant changes on any of the staff and client survey measures. In methadone programs, staff use of tobacco-related practices increased (P?Source

Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial.

Filed under: Methadone Side Effects

Crit Care. 2012 Mar 15; 16(2): R49
Wanzuita R, Figueiredo LF, Pfuetzenreiter F, Cavalcanti AB, Westphal GA

ABSTRACT: INTRODUCTION: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids, which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. METHODS: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and were using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. RESULTS: From the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (IC 95% 0.87 a 2.64; p = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (IC 95%: 1.22 a 5.69; p < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; IC 95% 1.17 a 3.63; p < 0.004). CONCLUSIONS: The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV. Source

Methadone Maintenance Therapy Outcomes in Iran.

Filed under: Methadone Side Effects

Subst Use Misuse. 2012 Mar 15;
Noori R, Narenjiha H, Aghabakhshi H, Habibi G, Khoshkrood Mansoori B

Introduction: Because of the increasing number of injecting drug users (IDUs) in Iran and the risk of the spread of HIV infection, harm reduction programs have been considered for conventional law enforcement measures. The aim of this study was to evaluate the efficacy of methadone maintenance therapy (MMT) in IDUs and the associated health and social outcomes. Material and Methods: This case-control study was conducted at the Persepolis Harm Reduction Center in Tehran during the year 2006. Data were gathered from two groups of randomly chosen patients. The first group consisted of 75 IDU patients who had undergone at least 6 months of methadone treatment (the MMT group), and second group consisted of 75 newly admitted clients (the control group). Participants were assessed on their dangerous injection and sexual behaviors, social well-being, and patterns of drug use. The results were compared between the two groups. Results: The mean age of participants in the two groups was almost the same (34.28 years in the control group and 35.68 years in the MMT group, p >.05). Prevalence of drug injection in the MMT group was less than that in the control group (16% vs. 100%). There was also a dramatic difference in needle and syringe sharing (40% in the control group vs. 4% in the MMT group) but not in crimes and arrests (p = .4). Those in the MMT group had a better relationship with their families, partners, coworkers, and neighbors compared with controls. There was no considerable difference in dangerous sexual behaviors between the two groups. Conclusions: Given the large number of HIV-positive cases among IDUs and considering that injection drug use is the main spreading factor for HIV, MMT would play a major role in controlling the HIV epidemic through reduction of heroin injection and the risk behaviors related to it. High inflation rate, lack of interorganization coordination, budget limitation, and no follow-up were the most important limitations of this study.
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Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment.

Filed under: Methadone Side Effects

CMAJ. 2012 Mar 12;
Nosyk B, Guh DP, Bansback NJ, Oviedo-Joekes E, Brissette S, Marsh DC, Meikleham E, Schechter MT, Anis AH

BACKGROUND:Although diacetylmorphine has been proven to be more effective than methadone maintenance treatment for opioid dependence, its direct costs are higher. We compared the cost-effectiveness of diacetylmorphine and methadone maintenance treatment for chronic opioid dependence refractory to treatment. METHODS:We constructed a semi-Markov cohort model using data from the North American Opiate Medication Initiative trial, supplemented with administrative data for the province of British Columbia and other published data, to capture the chronic, recurrent nature of opioid dependence. We calculated incremental cost-effectiveness ratios to compare diacetylmorphine and methadone over 1-, 5-, 10-year and lifetime horizons. RESULTS:Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each of the time horizons. Over a lifetime horizon, our model showed that people receiving methadone gained 7.46 discounted quality-adjusted life-years (QALYs) on average (95% credibility interval [CI] 6.91-8.01) and generated a societal cost of $ 1.14 million (95% CI $ 736 800-$ 1.78 million). Those who received diacetylmorphine gained 7.92 discounted QALYs on average (95% CI 7.32-8.53) and generated a societal cost of $ 1.10 million (95% CI $ 724 100-$ 1.71 million). Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity. Probabilistic sensitivity analysis showed that the probability of diacetylmorphine being cost-effective at a willingness-to-pay threshold of $ 0 per QALY gained was 76%; the probability was 95% at a threshold of $ 100 000 per QALY gained. Results were confirmed over a range of sensitivity analyses. INTERPRETATION:Using mathematical modelling to extrapolate results from the North American Opiate Medication Initiative, we found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment.
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Alcohol & Substance Abuse : Mental Side Effects of Methadone – Methadone is a treatment designed to help people with chronic pain relief or with the treatment of narcotic addiction, and the side effects include discomfort, difficulty focusing and anxiety. Find out why methadone’s side effects can sometimes be viewed as psychological withhelp from a licensed mental health counselor in this free video on narcotic addiction and substance abuse. Expert: David Thomas Contact: WTGTampa.com Bio: Dr. David Thomas has been certified as a licensed mental health counselor in the state of Florida since 1986 and in the National Board of Certified Counselors since 1987. Filmmaker: Christopher Rokosz

Negative side effects

Filed under: Methadone Side Effects

A recent move meant to cut down on the widespread abuse of a highly addictive prescription painkiller could have unintended negative effects — forcing addicts into involuntary withdrawal and increasing the already lucrative profits of street-level …
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Knowledge of Pain Med Safety Mixed Among Specialists

Filed under: Methadone Side Effects

When asked about their methadone prescribing habits, however, only 21% of the responding pain medicine specialists said they converted patients to another drug once their dose reached 100 mg, despite the risk for cardiovascular side effects; …
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