Coexisting Addiction and Pain in People Receiving Methadone for Addiction.

West J Nurs Res. 2013 Jul 15;
Marie BS

The aim of this qualitative study was to examine the narratives of people who experience chronic pain (lasting 6 months or more) and were receiving methadone for the treatment of their opiate addiction through a major methadone clinic. This paper featured the pathway of how the participants developed chronic pain and addiction, and their beliefs of how prescription opioids would impact their addiction in the future. Thirty-four participants who experienced chronic pain and received methadone for treatment of opiate addiction were willing to tell the story of their experiences. The findings in three areas are presented: (a) whether participants experienced addiction first or pain first and how their exposures to addictive substances influenced their experiences, (b) the significance of recreational drug use and patterns of abuse behaviors leading to chronic pain, and (c) participants’ experiences and beliefs about the potential for abuse of prescription opioid used for treatment of pain.
HubMed – Methadone

Hepatitis C virus infection is independently associated with depression among methadone maintenance treatment heroin users in China.

Asia Pac Psychiatry. 2012 Jul 27;
Wang Z, Du J, Zhao M, Page K, Xiao Z, Mandel JS

Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood.One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants’ symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients’ MMT clinical medical records.58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P?=?0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9?±?5.7. In logistic regression analysis, positive anti-HCV status (OR?=?3.75, 95% CI?=?1.42-9.90), and greater perceived stress (OR?=?1.23, 95% CI?=?1.11-1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection.Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.
HubMed – Methadone

Treating heroin addiction: Bridging the past and future – a Malaysian experience.

Asia Pac Psychiatry. 2012 Apr 18;
Robson N, Rashid R, Nazar M, Habil H

HubMed – Methadone

In vitro Inhibition of Methadone and Oxycodone Cytochrome P450-Dependent Metabolism: Reversible Inhibition by H2-Receptor Agonists and Proton-Pump Inhibitors.

J Anal Toxicol. 2013 Jul 14;
Moody DE, Liu F, Fang WB

In vitro inhibition of oxycodone metabolism to noroxycodone and oxymorphone and R- and S-methadone metabolism to R- and S-2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) was measured for four H2-receptor antagonists and five proton-pump inhibitors (PPIs) using human liver microsomes (HLM) and cDNA-expressed human cytochrome P450s (rCYPs). Inhibitors were first incubated with HLM at three concentrations with and without preincubation of inhibitor, enzyme source and reducing equivalents to also screen for time-dependent inhibition (TDI). Cimetidine and famotidine (10-1,000 µM) inhibited all the four pathways >50%. Nizatidine and ranitidine did not. All the five PPIs (1-200 µM) inhibited one or more pathways >50%. Half maximal inhibitory concentrations (IC50s) were then determined using rCYPs. Cimetidine and famotidine both inhibited CYP3A4-mediated formation of noroxycodone and CYP2D6-mediated formation of oxymorphone, and famotidine inhibited CYP3A4-mediated formation of R- and S-EDDP, but IC50s were so high that only >10× therapeutic concentrations may have potential for reversible in vivo inhibition. The PPIs were more potent inhibitors; many have the potential for reversible in vivo inhibition at therapeutic concentrations. Omeprazole, esomeprazole and pantoprazole had greater effects on CYP3A4-mediated reactions, whereas lansoprazole was selective for CYP2D6-mediated formation of oxymorphone. Preincubation enhanced cimetidine inhibition of noroxycodone formation and rabeprazole inhibition of all pathways. Future studies will explore irreversible TDI.
HubMed – Methadone

BPT Rant –Methadona–Mid Week–Laundry – Long awaited video, but there are better ones to come this weekend! Trust me! This one is just based on the methadone prg today and an argument with the crea…

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