Supporting mothers’ engagement in a community-based methadone treatment program.

Nurs Res Pract. 2013; 2013: 987463
Letourneau N, Campbell MA, Woodland J, Colpitts J

Unmanaged maternal opioid addiction poses health and social risks to both mothers and children in their care. Methadone maintenance treatment (MMT) is a targeted public health service to which nurses and other allied health professionals may refer these high risk families for support. Mothers participating in MMT to manage their addiction and their service providers were interviewed to identify resources to maximize mothers’ engagement in treatment and enhance mothers’ parenting capacity. Twelve mothers and six service providers were recruited from an outpatient Atlantic Canadian methadone treatment program. Two major barriers to engagement in MMT were identified by both mothers and service providers including (1) the lack of available and consistent childcare while mothers attended outpatient programs and (2) challenges with transportation to the treatment facility. All participants noted the potential benefits of adding supportive resources for the children of mothers involved in MMT and for mothers to learn how to communicate more effectively with their children and rebuild damaged mother-child relationships. The public health benefits of integrating parent-child ancillary supports into MMT for mothers are discussed.
HubMed – Methadone

Managing Psychiatric Comorbidity Within Versus Outside of Methadone Treatment Settings: A Randomized and Controlled Evaluation.

Addiction. 2013 Jun 4;
Brooner RK, Kidorf MS, King VL, Peirce J, Neufeld K, Stoller K, Kolodner K

BACKGROUND AND AIMS: Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of onsite and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes. DESIGN: Participants at the Addiction Treatment Services (ATS) were randomly assigned to receive onsite and integrated substance abuse and psychiatric care (ONSITE: n=160) versus offsite and non-integrated substance abuse and psychiatric care (OFFSITE: n=156), and observed for one year. ONSITE participants received all psychiatric care within the substance abuse program by the same group of treatment providers. The same type and schedule of psychiatric services were available to OFFSITE participants at a community psychiatry program. SETTING: All participants received routine methadone maintenance at the ATS program in Baltimore, Maryland, USA. PARTICIPANTS: Participants were opioid-dependent men and women with at least one comorbid psychiatric disorder as assessed by the Structured Clinical Interview for DSM-IV and confirmed by expert clinical reappraisal. MEASUREMENTS: Outcomes included psychiatric service utilization and retention, Hopkins Symptom Checklist Global Severity Index (GSI) change scores, and urinalysis test results. FINDINGS: ONSITE participants were more likely to initiate psychiatric care (97% vs. 80%, p < .001), remain in treatment longer (196 vs. 102 days; p < .001), attend more psychiatrist appointments (12.9 vs. 2.7; p < 0.001), and have greater reductions in GSI scores (4.2 vs. 1.7; p = .003) than OFFSITE participants; no differences were observed for drug use. CONCLUSIONS: Onsite and integrated psychiatric and substance misuse services in a methadone treatment setting may improve psychiatric outcomes compared with offsite and non-integrated substance misuse and psychiatric care. However this may not translate into improved substance misuse outcomes. HubMed – Methadone

Deviant Smooth Pursuit in Preschool Children Prenatally Exposed to Methadone or Buprenorphine and Tobacco affects Integrative Visuo-Motoric Capabilities.

Addiction. 2013 Jun 4;
Melinder A, Konijnenberg C, Sarfi M

BACKGROUND AND AIMS: Although an increasing number of children are born of mothers in opioid maintenance therapy (OMT), little is known about the long-term effects of these opioids. Previous studies suggest an association between prenatal OMT exposure and difficulties in eye movement control. Also, effects of tobacco smoking on eye movements have been reported. The present study examined the influence of eye movements, i.e., smooth pursuit, on visuo-motoric capabilities in children of smoking mothers in OMT. DESIGN: The study comprised a 2 (OMT vs. contrast group) x 2 (slow vs. fast smooth pursuit) between-subject factorial design. SETTING: The cognitive developmental research unit at the University of Oslo, Norway. PARTICIPANTS: Twenty-six 4-year-old children of tobacco-smoking women in OMT and 23 non-exposed 4-year-old children, with non-smoking mothers, matched by gender and age participated. MEASUREMENT: Eye movements and smooth pursuit were recorded using a Tobii 1750 eyetracker. Visuo-motoric functions were examined by Bender test. FINDINGS: The OMT group tracked slowly moving objects with smooth pursuit in a similar manner to their non-exposed peers. When fast smooth pursuit was measured, the OMT group of children tracked the object more slowly than the contrast group, p = .02, ?p(2) = .11. A regression analysis showed that fast smooth pursuit predicted children’s performance on a visuo-motoric task, R2 = .37. CONCLUSION: Impaired eye-tracking skills in 4-year-old children exposed to methadone or buprenorphine and tobacco prenatally may inhibit the development of some cognitive functions later in life.
HubMed – Methadone

False sense of safety by daily QTc interval monitoring during methadone IVPCA titration in a patient with chronic pain.

J Pain Res. 2013; 6: 375-8
Miranda-Grajales H, Hao J, Cruciani RA

It has been proposed that some deaths attributed to methadone are related to prolongation of the QTc interval; however, there are no clear recommendations on electrocardiogram (ECG) monitoring in patients undergoing intravenous methadone infusion. This is a report on a patient receiving methadone intravenous patient-controlled analgesia titration for the treatment of chronic pain. Initially, her daily ECGs showed QTc intervals within normal limits; however, she experienced a rapid increase in QTc interval from 317 ms to 784 ms within a 24-hour period after methadone had been discontinued for excessive sedation. QTc interval greater than 500 ms is considered to be high risk for the fatal arrhythmia Torsades de Pointes. Daily ECGs did not detect a gradual increase in the QTc interval that would have alerted the medical staff of the need to decrease or stop the methadone before reaching a prolonged QTc interval associated with cardiotoxicity. In selected cases where aggressive methadone titration is required, more intensive monitoring, such as telemetry or ECG determinations every 12 hours, might help detect changes in QTc interval duration that might otherwise be missed by daily ECG determinations.
HubMed – Methadone

The potential impact of expanding antiretroviral therapy and combination prevention in Vietnam: Towards elimination of HIV transmission.

J Acquir Immune Defic Syndr. 2013 May 24;
Kato M, Granich R, Duc Bui D, Tran HV, Nadol P, Jacka D, Sabin K, Suthar AB, Mesquita F, Lo YR, Williams B

BACKGROUND: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs (PWID). We investigated the impact of expanded HIV testing and counselling (HTC) and early ART, combined with other prevention interventions on HIV transmission. METHODS: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting sub-populations, and examining combined strategies with methadone maintenance therapy (MMT) and condom use. RESULTS: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections, and will cost USD 22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost USD 76.9 million. Annual HTC and immediate treatment offered only to PWID, will reduce new infections by 13,578 (75%), and will cost only USD 23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of MMT and condom use, will reduce new infections by 14,723 (81%) with similar costs (USD 22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years, and will result in a relative cost saving after 19 years. CONCLUSION: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.
HubMed – Methadone

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