The Methadone Menace.
The Methadone Menace.
Clin Infect Dis. 2013 Jul 29;
Mason JW
Risk of QTc prolongation in a cohort of opioid-dependent HIV-infected patients on methadone maintenance therapy.
Clin Infect Dis. 2013 Jul 29;
Vallecillo G, Mojal S, Roquer A, Martinez D, Rossi P, Fonseca F, Muga R, Torrens M
Background.?Concern regarding the QTc interval in HIV-infected patients has been growing in recent years, and cases of prolonged QTc interval and Torsades de Pointes have been described in HIV-infected patients on methadone therapy. This study aimed to determine the prevalence and factors associated with long QTc interval in a cohort of opioid-dependent HIV-infected patients on methadone maintenance therapy. Methods.?A cross-sectional study was conducted in opioid-dependent HIV-infected patients on methadone maintenance therapy at a drug abuse outpatient center. Patients with any cardiac disease, drug-positive urine test, electrolyte abnormalities and changes in their antiretroviral therapy or methadone doses in the last two months were excluded. Heart rate and QT interval in lead II were measured using Bazett’s formula. Results.?Ninety-one patients were included: 58 (63.7%) were males with a median age of 44.5 years and 68/91 (74.7%) were on antiretroviral therapy. Median methadone dose was 70 (15-250) mg/day and mean QTc interval 438+34 ms. Prolonged QTc interval (>450 ms) was documented in 33/91(36.3%) patients and 3/91 (3.2%) had QTc >500 ms. On multiple linear regression analysis methadone doses (P 0.005), chronic hepatitis C-induced cirrhosis (P 0.008) and antiretroviral naive therapy (P 0.036) were predictive of prolonged QTc. Conclusions.?The prevalence of prolonged QTc interval in opioid-dependent HIV-infected patients on methadone maintenance therapy is high. Risk factors for prolongation of the QTc interval are chronic hepatitis C-induced cirrhosis, higher methadone doses and antiretroviral-naive therapy. Thus, ECG monitoring is required to minimize cardiovascular morbidity and mortality in this specific HIV group.
HubMed – Methadone
Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management.
Pain Med. 2013 Jul 30;
Melanson SE, Ptolemy AS, Wasan AD
It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient.Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management.We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated.The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were <1% so we eliminated this testing from our panel. We also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, we changed our testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, due the high rate of false negative results using our immunoassay-based benzodiazepine screen, we removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry.Conducting an interdisciplinary quality improvement project allowed us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. HubMed – Methadone
TVNR-Health Package-Methadone Clinic – TV News Reporting Package #3- Health Package. Methadone Clinic to be place in Holmesburg on Frankford Ave and Decatur Street.
More Methadone Treatment Information…