A Metaphor Analysis of Recovering Substance Abusers’ Sensemaking of Medication-Assisted Treatment.

Qual Health Res. 2013 May 6;
Malvini Redden S, Tracy SJ, Shafer MS

In this study, we examined metaphors invoked by people recovering from opioid dependence as they described the challenges and successes of using medication-assisted treatment. Metaphors provide linguistic tools for expressing issues that are confusing, complex, hidden, and difficult to state analytically or literally. Using data from eight focus groups with 68 participants representing four ethnic minority groups, we conducted a grounded analysis to show how recovering substance users communicatively constructed addiction and recovery. The primary medication, methadone, was framed as “liquid handcuffs” that allowed those in recovery to quit “hustling,” get “straight,” and find “money in their pockets.” Nonetheless, methadone also served as a “crutch,” leaving them still feeling like “users” with “habits” who “came up dirty” to friends and family. In this analysis, we tease out implications of these metaphors, and how they shed light on sensemaking, agency, and related racial- and class-based structural challenges in substance abuse recovery.
HubMed – Methadone

Effects of Disulfiram on QTc Interval in Non-Opioid-Dependent and Methadone-Treated Cocaine-Dependent Patients.

J Addict Med. 2013 May 3;
Atkinson TS, Sanders N, Mancino M, Oliveto A

OBJECTIVES:: Methadone and cocaine are each known to prolong the QTc interval, a risk factor for developing potentially fatal cardiac arrhythmias. Disulfiram, often administered in the context of methadone maintenance to facilitate alcohol abstinence, has been shown to have some efficacy for cocaine dependence. Disulfiram has differential effects on cocaine and methadone metabolism, but its impact on methadone- or cocaine-induced changes in QTc interval is unclear. Thus, the effects of disulfiram on QTc interval in a subset of cocaine-dependent patients participating in a 14-week, randomized, double-blind, placebo-controlled clinical trial of disulfiram were prospectively determined. METHODS:: Opioid-dependent participants were inducted onto methadone (weeks 1-2; MT) and both MT and non-opioid-dependent (UT) participants were randomized to receive disulfiram (weeks 3-14) at one of the following doses: 0, 250, 375, or 500 mg/d. Electrocardio-grams were obtained before study entry and during weeks 2 and 4. RESULTS:: Complete QTc-interval data in 23 MT and 18 UT participants were analyzed. QTc interval tended to be higher in MT participants relative to UT participants, regardless of disulfiram dose and time point, but disulfiram did not differentially alter QTc interval. QTc interval was, however, significantly greater in participants with recent cocaine use than in those with no recent use. CONCLUSIONS:: These results suggest that cocaine use and possibly MT status, but not disulfiram, are risk factors for QTc prolongation.
HubMed – Methadone

Very-High-Dose Methadone With Minimal Toxicity and Inadequate Pain Control in a Hospice Patient With Cancer.

J Pain Palliat Care Pharmacother. 2013 May 6;
Latuga NM, Wahler RG

ABSTRACT A case is reported of a 48-year-old Caucasian male who was admitted to hospice care with metastatic cancer of the larynx. The patient required very high methadone doses and experienced little opioid toxicity. The pharmacodynamics and pharmacokinetics of methadone are discussed in the context of this patient experience.
HubMed – Methadone

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