What Is Low Threshold Methadone Maintenance Treatment?
What is low threshold methadone maintenance treatment?
Int J Drug Policy. 2013 Jun 3;
Strike C, Millson M, Hopkins S, Smith C
BACKGROUND: Low threshold methadone maintenance (MMT) was developed for clients who do not have abstinence as a treatment goal. We explored how MMT programs in Canada defined low threshold and the challenges they faced. METHODS: Using semi-structured interviews, we collected data from clients (n=46), nurses/counsellors (n=15) and physicians (n=9) at three low threshold MMT programs. All participants were asked to define low threshold MMT and describe how it was implemented in practice. Interviews were taped, transcribed, verified and analysed using an iterative thematic coding technique. RESULTS: Low threshold MMT was defined by an explicit rejection of abstinence from opiates and other drugs as an over-arching treatment goal. In the absence of guidelines defining a set of practices as low threshold, programs implemented practices they believed would reduce barriers to admission and help retention. There was not always agreement between professional groups or across the programs regarding these practices. For physicians, there was a tension between accepting poly-drug use during treatment as a means to improve retention, with an obligation to do more good than harm for their patients. Missed prescribing appointments generated few to severe consequences and revealed differential focus on reducing barriers versus encouraging client ‘ownership’ of treatment. Differences of opinion regarding appropriate urine drug testing practices revealed power dynamics between medical and non-medical staff. CONCLUSION: Our findings show that there are potentially more ways to reduce barriers to MMT than those presented in the current literature. Our findings are important given the growing number of people with opiate dependence across the world and calls to increase access to MMT. To fully develop the low threshold model, it will be important to evaluate what policies and practices can achieve the goals of reducing barriers to admission and improving retention in treatment.
HubMed – Methadone
Parallel artificial liquid membrane extraction: micro-scale liquid-liquid-liquid extraction in the 96-well format.
Bioanalysis. 2013 Jun; 5(11): 1377-85
Gjelstad A, Rasmussen KE, Parmer MP, Pedersen-Bjergaard S
Background: This paper reports development of a new approach towards analytical liquid-liquid-liquid membrane extraction termed parallel artificial liquid membrane extraction. A donor plate and acceptor plate create a sandwich, in which each sample (human plasma) and acceptor solution is separated by an artificial liquid membrane. Parallel artificial liquid membrane extraction is a modification of hollow-fiber liquid-phase microextraction, where the hollow fibers are replaced by flat membranes in a 96-well plate format. Results: Four basic drugs (pethidine, nortriptyline, methadone and haloperidol) were extracted from human plasma in 30 min, followed by analysis with LC-MS/MS. Extraction recoveries for the model analytes were in the range of 34-74% from human plasma. LOQs were in the range of 0.01-0.35 ng/ml, linearity above 0.9955 for all drugs and with RSD values below 12%. Conclusion: Liquid-liquid-liquid membrane extraction was successfully performed in a slightly modified commercially available 96-well plate format.
HubMed – Methadone
A multicentre survey of hepatitis C awareness in a high-risk population.
J Paediatr Child Health. 2013 Jun 7;
Kanaan T, Liu A, Leroi M, Nanan R
AIMS: To assess the awareness of hepatitis C virus (HCV) infection status in a high-risk population. METHODS: A targeted population survey of clients of methadone maintenance clinics in metropolitan and rural New South Wales, using an interviewer-administered face-to-face questionnaire. Main outcome measures include awareness of HCV status, time elapsed since last tested and children’s HCV status. RESULTS: A total of 329 clients completed the survey, of which 97% perceived to have been tested for HCV in the past. One hundred and seventy (52%) participants considered themselves to be negative for HCV. Of these the median time since last tested was 2 years (2 weeks-25 years). Although 94% of all parents believed that their child’s HCV status was negative, only 49% of respondents stated that their children had been tested for HCV. Voluntary testing was offered to all clients and their children with only one accepting. CONCLUSIONS: Awareness of HCV infection status in this high-risk population is suboptimal. This indicates that existing educational strategies are inadequate and that there is a disconnect between their health needs and the medical care they receive. Novel approaches need to be considered to improve the knowledge of HCV transmission and hopefully improve HCV-associated health outcomes in high-risk populations.
HubMed – Methadone
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