Lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women.

Filed under: Methadone Clinics

Hum Psychopharmacol. 2012 Nov 13;
Winklbaur-Hausknost B, Jagsch R, Graf-Rohrmeister K, Unger A, Baewert A, Langer M, Thau K, Fischer G

OBJECTIVES: Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials. METHODS: Two double-blind, double-dummy, randomized controlled trials (Pilot study, European sample of MOTHER-trial) comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted. In both studies, participants received voucher-based incentives for attendance and completion of study assessments. In the MOTHER trial, participants additionally received escalating voucher incentives for drug-free urine samples. Neonatal abstinence syndrome was treated with oral morphine solution based on standardized modified Finnegan scores. RESULTS: After a mean treatment period of 13.79?weeks in the Pilot study (PS, n?=?18) and 20.78?weeks in the MOTHER-trial (MT, n?=?41), respectively (p?HubMed – Methadone

Computational-aided design of molecularly imprinted polymer for selective extraction of methadone from plasma and saliva and determination by gas chromatography.

Filed under: Methadone Clinics

J Chromatogr A. 2012 Oct 23;
Ahmadi F, Rezaei H, Tahvilian R

The main objective of this research was computational designing of an imprinted polymer for selective solid phase extraction (SPE) of methadone from plasma and saliva samples analyzed by gas chromatography-flam ionization detector (GC-FID). The density functional theory (DFT) at B3LYP/6-31G+ (d, p) level and Gaussian 2003 package was used to calculate the interaction energy of template-monomers (?E). The effect of polymerization solvent was also studied using polarizable continuum model (PCM). It was shown that, methacrylic acid (MAA) gave the largest ?E in acetonitrile as a polymerization solvent. To examine the validity of this approach, two MIP were synthesized for methadone as template molecule and methacrylic acid as functional monomer in acetonitrile (AN) and methanol (MeOH), respectively. The performance of each polymer was evaluated by using imprinting effect. As it is expected, the best results were obtained for the molecularly imprinted polymer (MIP) which was prepared in AN. For the optimized method, the linearity between responses (peak areas) and concentration of methadone in plasma and saliva samples were found over the range of 3.6-40,000ngmL(-1) (R(2)=0.997) and 3.0-40,000ngmL(-1) (R(2)=0.998), respectively. The limit of detection (LOD) and limit of quantification (LOQ) for methadone in plasma were calculated to be 2.45 and 3.6ngmL(-1), respectively. The LOD and LOQ for methadone in saliva were 2.14 and 3.0ngmL(-1), respectively. The relative standard deviation (RSD; n=4) for plasma samples containing 10, 100, 500, 1000ngmL(-1)of methadone were 5.98, 5.78, 5.52, 4.78, 4.74, and the RSD (n=4) for saliva sample containing 5, 20, 100, 1000ngmL(-1) of methadone were 4.74, 5.1, 5.9, 5.6, respectively.
HubMed – Methadone

Methadone for chronic non-cancer pain in adults.

Filed under: Methadone Clinics

Cochrane Database Syst Rev. 2012; 11: CD008025
Haroutiunian S, McNicol ED, Lipman AG

Methadone belongs to a class of analgesics known as opioids, that are considered the cornerstone of therapy for moderate-to-severe pain due to life-threatening illnesses; however, their use in chronic non-cancer pain (CNCP) is controversial. Methadone has many characteristics that differentiate it from other opioids, which suggests that it may have a different efficacy and safety profile.To assess the analgesic effectiveness and safety of methadone in the treatment of CNCP.We identified both randomized controlled trials (RCTs) and non-randomized studies of methadone use in chronic pain by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2011, issue 11, MEDLINE (1950 to November 2011), and EMBASE (1980 to November 2011), together with reference lists of retrieved papers and reviews.We included RCTs with pain assessment as either the primary or secondary outcome. Quasi-randomized studies, cohorts and case-control trials were also considered for inclusion because we suspected that the beneficial and harmful effects of methadone in CNCP may not be adequately addressed in RCTs.Two review authors independently extracted efficacy and adverse event data and assessed risk of bias.We included two RCTs and one non-randomized study, involving a total of 181 participants. Both RCTs were cross-over studies, one involving 19 participants with diverse neuropathic pain syndromes, the other involving 76 participants with postherpetic neuralgia. Study phases were 20 days and approximately eight weeks, respectively. The non-randomized study retrospectively evaluated 86 outpatients over an average of 8.8 ± 6.3 months.One RCT reported average pain intensity and pain relief, and found statistically significant improvements versus placebo for both outcomes, with 10 mg and 20 mg daily doses of methadone. The second RCT reported differences in pain reduction between methadone and morphine and found morphine to be statistically superior. The non-randomized study found that in patients initially prescribed methadone it was effective in fewer participants than in those initially prescribed other long-acting opioids (28% versus 42%, 33% and 50% for morphine, oxycodone and transdermal fentanyl, respectively).One RCT compared incidences for several individual adverse events, but found a difference between methadone and placebo for only one event, dizziness (P = 0.041).The three studies provide very limited evidence of the efficacy of methadone for CNCP, and there were too few data for pooled analysis of efficacy or harm, or to have confidence in the results of the individual studies. No conclusions can be made regarding differences in efficacy or safety between methadone and placebo, other opioids, or other treatments.
HubMed – Methadone

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