(1) H-nuclear magnetic resonance-based metabonomic analysis of brain in rhesus monkeys with morphine treatment and withdrawal intervention.

Filed under: Methadone Treatment

J Neurosci Res. 2012 Jul 30;
Deng Y, Bu Q, Hu Z, Deng P, Yan G, Duan J, Hu C, Zhou J, Shao X, Zhao J, Li Y, Zhu R, Zhao Y, Cen X

Comprehensive cerebral metabolites involved in morphine dependence have not been well explored. To gain a better understanding of morphine dependence and withdrawal therapy in a model highly related to humans, metabolic changes in brain hippocampus and prefrontal cortex (PFC) of rhesus monkeys were measured by (1) H-nuclear magnetic resonance spectroscopy, coupled with partial least squares and orthogonal signal correction analysis. The results showed that concentrations of myoinositol (M-Ins) and taurine were significantly reduced, whereas lactic acid was increased in hippocampus and PFC of morphine-dependent monkeys. Phosphocholine and creatine increased in PFC but decreased in hippocampus after chronic treatment of morphine. Moreover, N-acetyl aspartate (NAA), ?-aminobutyric acid, glutamate, glutathione, methionine, and homocysteic acid also changed in these brain regions. These results suggest that chronic morphine exposure causes profound disturbances of neurotransmitters, membrane, and energy metabolism in the brain. Notably, morphine-induced dysregulations in NAA, creatine, lactic acid, taurine, M-Ins, and phosphocholine were clearly reversed after intervention with methadone or clonidine. Our study highlights the potential of metabolic profiling to enhance our understanding of metabolite alteration and neurobiological actions associated with morphine addiction and withdrawal therapy in primates. © 2012 Wiley Periodicals, Inc.
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A Model to Identify Patients at Risk for Prescription Opioid Abuse, Dependence, and Misuse.

Filed under: Methadone Treatment

Pain Med. 2012 Jul 30;
Rice JB, White AG, Birnbaum HG, Schiller M, Brown DA, Roland CL

Objective.? The objective of this study was to use administrative claims data to identify and analyze patient characteristics and behavior associated with diagnosed opioid abuse. Design.? Patients, aged 12-64 years, with at least one prescription opioid claim during 2007-2009 (n?=?821,916) were selected from a de-identified administrative claims database of privately insured members (n?=?8,316,665). Patients were divided into two mutually exclusive groups: those diagnosed with opioid abuse during 1999-2009 (n?=?6,380) and those without a diagnosis for opioid abuse (n?=? 815,536). A logistic regression model was developed to estimate the association between an opioid abuse diagnosis and patient characteristics, including patient demographics, prescription drug use and filling behavior, comorbidities, medical resource use, and family member characteristics. Sensitivity analyses were conducted on the model’s predictive power. Results.? In addition to demographic factors associated with abuse (e.g., male gender), the following were identified as “key characteristics” (i.e., odds ratio [OR]?>?2): prior opioid prescriptions (OR?=?2.23 for 1-5 prior Rxs; OR?=?6.85 for 6+ prior Rxs); at least one prior prescription of buprenorphine (OR?=?51.75) or methadone (OR?=?2.97); at least one diagnosis of non-opioid drug abuse (OR?=?9.89), mental illness (OR?=?2.45), or hepatitis (OR?=?2.36); and having a family member diagnosed with opioid abuse (OR?=?3.01). Conclusions.? Using medical as well as drug claims data, it is feasible to develop models that could assist payers in identifying patients who exhibit characteristics associated with increased risk for opioid abuse. These models incorporate medical information beyond that available to prescription drug monitoring programs that are reliant on drug claims data and can be an important tool to identify potentially inappropriate opioid use.
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Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009.

Filed under: Methadone Treatment

Drug Alcohol Depend. 2012 Jul 25;
Welle-Strand GK, Skurtveit S, Jones HE, Waal H, Bakstad B, Bjarkø L, Ravndal E

BACKGROUND: In Norway, most opioid-dependent women are in opioid maintenance treatment (OMT) with either methadone or buprenorphine throughout pregnancy. The inclusion criteria for both medications are the same and both medications are provided by the same health professionals in any part of the country. International studies comparing methadone and buprenorphine in pregnancy have shown differing neonatal outcomes for the two medications. METHOD: This study compared the neonatal outcomes following prenatal exposure to either methadone or buprenorphine in a national clinical cohort of 139 women/neonates from 1996 to 2009. RESULTS: After adjusting for relevant covariates, buprenorphine-exposed newborns had larger head circumferences and tended to be heavier and longer than methadone-exposed newborns. The incidence of neonatal abstinence syndrome (NAS) and length of treatment of NAS did not differ between methadone- and buprenorphine-exposed newborns. There was little use of illegal drugs and benzodiazepines during the pregnancies. However, the use of any drugs or benzodiazepines during pregnancy was associated with longer lasting NAS-treatment of the neonates. CONCLUSIONS: The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs.
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Shared and unique genetic contributions to attention deficit/hyperactivity disorder and substance use disorders: A pilot study of six candidate genes.

Filed under: Methadone Treatment

Eur Neuropsychopharmacol. 2012 Jul 26;
Carpentier PJ, Arias Vasquez A, Hoogman M, Onnink M, Kan CC, Kooij JJ, Makkinje R, Iskandar S, Kiemeney LA, de Jong CA, Franke B, Buitelaar JK

The shared genetic basis of attention deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) was explored by investigating the association of candidate risk factors in neurotransmitter genes with both disorders. One hundred seven methadone maintenance treatment patients, 36 having an ADHD diagnosis, 176 adult patients with ADHD without SUDs, and 500 healthy controls were genotyped for variants in the DRD4 (exon 3 VNTR), DRD5 (upstream VNTR), HTR1B (rs6296), DBH (rs2519152), COMT (rs4680; Val158Met), and OPRM1 (rs1799971; 118A>G) genes. Association with disease was tested using logistic regression models. This pilot study was adequately powered to detect larger genetic effects (OR?2) of risk alleles with a low frequency. Compared to controls, ADHD patients (with and without SUDs) showed significantly increased frequency of the DBH (rs2519152: OR 1.73; CI 1.15-2.59; P=0.008) and the OPRM1 risk genotypes (rs1799971: OR 1.71; CI 1.17-2.50; P=0.006). The DBH risk genotype was associated with ADHD diagnosis, with the association strongest in the pure ADHD group. The OPRM1 risk genotype increased the risk for the combined ADHD and SUD phenotype. The present study strengthens the evidence for a shared genetic basis for ADHD and addiction. The association of OPRM1 with the ADHD and SUD combination could help to explain the contradictory results of previous studies. The power limitations of the study restrict the significance of these findings: replication in larger samples is warranted.
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Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005¿2010).

Filed under: Methadone Treatment

BMC Public Health. 2012 Jul 29; 12(1): 572
Ni M, Fu L, Chen X, Hu X, Wheeler K

ABSTRACT: BACKGROUND: To quantify the contribution of locally implemented prevention programmes in contributing to reductions in treatment and care costs by averting HIV infections among those who inject drugs this study calculates net financial benefit of providing harm reduction programmes using information from services being implemented in Urumqi, Xinjiang Uighur Autonomous Region of China (2005 and 2010). METHODS: Information was collected to assess cost of providing methadone treatment (MMT) and needle and syringe programmes (NSP). HIV incidence was estimated among people who inject drugs (PWID). HIV infections averted were calculated. Net benefit was assessed by estimating costs of providing prevention programmes and comparing these to the costs of providing care. RESULTS: An estimated 5678 (range 3982-7599) HIV infections were averted between 2005 and 2010 and the net financial benefit of providing harm reduction programmes compared to treatment and care costs for HIV infections averted was USD 4.383 million during the same time period. CONCLUSION: These results demonstrate the net and accumulating benefit of investing in harm reduction programmes for PWID in Urumqi. The return on investment has been progressively increasing during the time period studied and it is clear that these cost savings will continue to accrue with the continued implementation of HIV prevention interventions in the community that include harm reduction programmes targeted at PWID.
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Methadone deaths still high but may have peaked

Filed under: Methadone Treatment

And in 2008, methadone manufacturers voluntarily limited distribution of the largest doses of the drug to only hospitals and to addiction treatment programs. Meanwhile, more states started or toughened up programs to monitor prescriptions for …
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Methadone clinic's site an issue, DA says

Filed under: Methadone Treatment

… secrecy surrounding potential locations of a methadone clinic in the city, Berkshire District Attorney David Capeless said he would like to see public disclosure by Spectrum Health Systems of any sites being considered for treatment of opioid drug …
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