Cost-effectiveness of integrating methadone maintenance and antiretroviral treatment for HIV-positive drug users in Vietnam’s injection-driven HIV epidemics.

Filed under: Methadone Clinics

Drug Alcohol Depend. 2012 Mar 19;
Tran BX, Ohinmaa A, Duong AT, Nguyen LT, Vu PX, Mills S, Houston S, Jacobs P

Drug use negatively affects adherence to and outcomes of antiretroviral treatment (ART). This study evaluated the cost-effectiveness of integrating methadone maintenance treatment (MMT) with ART for HIV-positive drug users (DUs) in Vietnam. A decision analytical model was developed to compare the costs and consequences of 3 HIV/AIDS treatment strategies for DUs: (1) only ART, (2) providing ART and MMT in separated sites (ART-MMT), and (3) integrating ART and MMT with direct administration (DAART-MMT). The model was parameterized using empirical data of costs and outcomes extracted from the MMT and ART cohort studies in Vietnam, and international published sources. Probabilistic sensitivity analysis was conducted to examine the model’s robustness. The base-case analysis showed that the cost-effectiveness ratio of ART, DAART-MMT, and ART-MMT strategies was USD 1358.9, 1118.0 and 1327.1 per 1 Quality-Adjusted Life Year (QALY), equivalent to 1.22, 1.00, and 1.19 times Gross Domestic Product per capita (GDPpc). The incremental cost-effectiveness ratio for DAART-MMT and ART-MMT versus ART strategy was 569.4 and 1227.8, approximately 0.51 and 1.10 times GDPpc/QALY. At the willingness to pay threshold of 3 times GDPpc, the probability of being cost-effective of DAART-MMT versus ART was 86.1%. These findings indicated that providing MMT along with ART for HIV-positive DUs is a cost-effective intervention in Vietnam. Integrating MMT and ART services could facilitate the use of directly observed therapy that supports treatment adherence and brings about clinically important improvements in health outcomes. This approach is also incrementally cost-effective in this large injection-driven HIV epidemic.
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Severe central sleep apnea in a child with leukemia on chronic methadone therapy.

Filed under: Methadone Clinics

Pediatr Pulmonol. 2012 Mar 19;
Amos LB, D’Andrea LA

We describe a child with acute myeloid leukemia (AML) who developed severe central sleep apnea (CSA) on methadone therapy for chronic pain management. His chemotherapy-related cerebral atrophy and renal insufficiency with impaired methadone clearance may have also contributed to the severity of his sleep-disordered breathing. Maintenance methadone treatment is not a common pediatric practice; therefore, the adverse effects of methadone therapy, including CSA, are rarely reported in children. Pediatr Pulmonol. © 2012 Wiley Periodicals, Inc.
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Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan.

Filed under: Methadone Clinics

Subst Abuse Treat Prev Policy. 2012 Mar 20; 7(1): 11
Lee HY, Li JH, Wu LT, Wu JS, Yen CF, Tang HP

ABSTRACT: BACKGROUND: Although methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community. METHODS: The study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged [greater than or equal to] 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) [greater than or equal to] 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined. RESULTS: 128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP. CONCLUSIONS: The results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients.
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Methadone clinic data reveals deepening problem

Filed under: Methadone Clinics

BY KEVIN LITTEN REPUBLICAN-AMERICAN TORRINGTON — State data provided to the nonprofit company planning a methadone clinic for Kennedy Drive suggests Northwest Connecticut faces a deepening drug problem that was once seen as an exclusively urban …
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Officials say methadone clinic too close to day care

Filed under: Methadone Clinics

By Damian Mann / Mail Tribune (Medford ) MEDFORD — Medford officials have ordered a methadone clinic on East Main Street to cease operations within 90 days after the city discovered it is too close to a day care center. City Attorney Kevin McConnell …
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St. Louis County Board critical of second methadone clinic

Filed under: Methadone Clinics

Plans for a second methadone treatment center for drug addicts in Duluth have raised the ire of St. Louis County commissioners. Plans for a second methadone treatment center for drug addicts in Duluth have raised the ire of St. Louis County …
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