Pharmacological Maintenance Treatments of Opiate Addiction.

Filed under: Methadone Side Effects

Br J Clin Pharmacol. 2012 Dec 4;
Bell J

For people seeking treatment, the course of heroin addiction tends to be chronic and relapsing, and longer duration of treatment is associated with better outcomes. Heroin addiction is strongly associated with deviant behaviour and crime, and the objectives in treating heroin addiction have been a blend of humane support, rehabilitation, public health intervention, and crime control. Reduction in street heroin use is the foundation on which all these outcomes are based. The pharmacological basis of maintenance treatment of dependent individuals is minimizing withdrawal symptoms, and attenuating the reinforcing effects of street heroin, leading to reduction or cessation of street heroin use. Opioid maintenance treatment can be moderately effective in suppressing heroin use, although deviations from evidence-based approaches, particularly the use of suboptimal doses, have meant that treatment as delivered in practice may have resulted in poorer outcomes than predicted by research. Methadone treatment has been “programmatic”, with a one-size-fits-all approach which in part reflects the perceived need to impose discipline on deviant individuals. However, differences in pharmacokinetics and in side-effects mean that many patients do not respond optimally to methadone. Injectable diamorphine (heroin) provides a more reinforcing medication for some “non-responders”, and can be a valuable option in the rehabilitation of demoralised, socially-excluded individuals. Buprenorphine, a partial agonist, is a less reinforcing medication with different side-effects and less risk of overdose. It represents not only a different medication, but can also be used in a different paradigm of treatment, office-based opioid treatment, with less structure and offering greater patient autonomy.
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[The risk behavior of drug addicts requires holistic approach from the society. Syringe exchange and methadone-/buprenorphine treatment are important elements].

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Lakartidningen. 2012 Jun 19-26; 109(25): 1216-7
Håkansson AC

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Vital signs: risk for overdose from methadone used for pain relief – United States, 1999-2010.

Filed under: Methadone Side Effects

MMWR Morb Mortal Wkly Rep. 2012 Jul 6; 61(26): 493-7

Vital statistics data suggest that the opioid pain reliever (OPR) methadone is involved in one third of OPR-related overdose deaths, but it accounts for only a few percent of OPR prescriptions.CDC analyzed rates of fatal methadone overdoses and sales nationally during 1999-2010 and rates of overdose death for methadone compared with rates for other major opioids in 13 states for 2009.Methadone overdose deaths and sales rates in the United States peaked in 2007. In 2010, methadone accounted for between 4.5% and 18.5% of the opioids distributed by state. Methadone was involved in 31.4% of OPR deaths in the 13 states. It accounted for 39.8% of single-drug OPR deaths. The overdose death rate for methadone was significantly greater than that for other OPR for multidrug and single-drug deaths.Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing. Providers should use methadone as an analgesic only for conditions where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice by prescribers or insurers.
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