[When and how to detoxify clients from methadone maintenance treatment?]

Filed under: Methadone Clinics

Presse Med. 2012 May 28;
Ksouda K, Bloch V, Dugarin J, Dupuy G, Laqueille X, Lépine JP, Vorspan F

BACKGROUND: Methadone is prescribed in France as a maintenance treatment for heroin dependence since 1969. Nevertheless, the optimal duration of methadone maintenance treatment and how detoxification from methadone at the end of the treatment should be performed is still discussed. OBJECTIVE: To conduct a literature review on when and how detoxify clients from methadone maintenance treatment and to collect the opinion of experts in the field. DOCUMENTARY SOURCES: We searched the PubMed, Embase, Cochrane Library and PsycINFO databases on the 1966-2011 period using the keywords “methadone”, “maintenance”, “detoxification”, “tapering”, “cessation”, “withdrawal”. We also searched data in other addictive journals in French that are not available in those databases. We also collected the opinion of the physician in charge of the oldest methadone program in France (1969). STUDIES SELECTION: We excluded studies that used methadone as short time treatment of heroin withdrawal and thus selected 23 articles. RESULTS: There is a consensus on when methadone maintenance treatment should be stopped, defined by the client’s will to stop, the judgement from the physician that the client has been stable for a period of time that is long enough, but also the client’s motivation to live his life without maintenance treatment. There is also a majority, among articles on how methadone treatment should be stopped, recommending ambulatory, practical approaches using slow tapering of the dose, with the ability to go back to the previous dose if needed, namely in case of relapse to heroin use, heavy withdrawal or psychiatric symptoms. LIMITS: There are few articles addressing the subject, especially comparing prospectively different cessation strategies. CONCLUSION: Methadone maintenance treatment should not necessarily be maintained all life long and can be stopped within its prescription setting, including medical, psychological and social evaluation.
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Diabetes mellitus affects the duration of action of vecuronium in dogs.

Filed under: Methadone Clinics

Vet Anaesth Analg. 2012 May 30;
Clark L, Leece EA, Brearley JC

Objective? To compare the duration of action of vecuronium in diabetic dogs with a control group. Study design? Prospective clinical study. Animals? Forty client-owned diabetic (n?=?20) and non-diabetic dogs. Methods? Dogs were considered free from other concurrent disease based on clinical examination and laboratory data. After pre-anaesthetic medication with acepromazine and methadone, anaesthesia was induced with intravenous (IV) propofol and maintained with isoflurane-nitrous oxide in oxygen. Neuromuscular blockade (NMB) was achieved with vecuronium, 0.1?mg?kg(-1) IV and its effects recorded by palpation (pelvic limb digital extension) and electromyography (m. tibialis cranialis) of responses (twitches; T) to repeated train-of-four (TOF) nerve stimulation. Time to onset of NMB was the period between vecuronium injection and loss of fourth twitch (T4) in the TOF pattern recorded by EMG and palpation. Duration of NMB was defined as the time from drug administration to return of T1 by palpation (T1(tactile) ) and EMG (T1(EMG) ). Times to return of T2-4 were also recorded. Time from induction of anaesthesia to vecuronium injection was recorded. Heart rate, non-invasive mean arterial pressure, body temperature, end-tidal isoflurane and end-tidal CO(2) concentrations were recorded at onset of NMB and when T1(EMG) returned. Loss and return of palpable and EMG responses for diabetic and non-diabetic dogs were compared using t-tests and Mann Whitney U-tests. Results? There were significant (p?Source

Subsequent anxiety-related behavior in rats exposed to low-dose methadone during gestation, lactation or both periods consecutively.

Filed under: Methadone Clinics

Pharmacol Biochem Behav. 2012 May 24;
Daly FM, Hughes RN, Woodward LJ

In order to assess the long-term behavioral consequences of exposing rats to methadone during gestation, lactation or both periods consecutively, pregnant Wistar dams were provided with drinking water containing approximately 2.39mg/kg/day methadone. Soon after birth, litters of offspring were assigned to methadone-naïve foster mothers. Half of these foster mothers were then provided with drinking water containing methadone (approximately 2.86mg/kg/day), while the other half received unadulterated water. Maternal weight gain, pregnancy duration, litter sizes, sex ratios and average pup weights were recorded. Following weaning on postnatal day (PND) 28, individual rats were weighed and inspected for physical abnormalities and stress reactions at PND20, 60 and 120. At these same ages, observations were also made of the rats’ behavior in an emergence apparatus, and an open field. Apart from a smaller number of full-term pregnancies, there were no effects of any type of methadone treatment on physical measurements recorded at any age. Nor were there any behavioral effects of gestational methadone experienced on its own. However, methadone experienced during lactation (without gestational exposure) decreased emergence speed at PND30, and for all testing ages combined, increased open-field ambulation (males only), walking, rearing and occupancy of the center of the apparatus. Exposure to methadone during both gestation and lactation decreased emergence latencies at PND30 and, for all ages combined, decreased ambulation (males only), center occupancy and defecation. The subsequent behavioral effects of methadone were largely confined to lactational exposure and, when combined with gestational exposure, suggested increased anxiety.
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Methadone-mediated autonomic functioning of male patients with heroin dependence: the influence of borderline personality pattern.

Filed under: Methadone Clinics

PLoS One. 2012; 7(5): e37464
Huang WL, Lin YH, Kuo TB, Chang LR, Chen YZ, Yang CC

We hypothesize that the population with borderline personality shows different autonomic response to methadone compared to individuals with other personalities. This study applies heart rate variability (HRV) measurements and the Tridimensional Personality Questionnaire (TPQ) to examine this hypothesis.Forty-four male patients with heroin dependence were recruited from a methadone maintenance treatment program. Eight personality patterns were classified according to the TPQ norm used in Taiwan. The borderline pattern (BP, composed of high novelty seeking, high harm avoidance and low reward dependence) and the other personality patterns (OP) were separated into two groups. We compared the HRV profiles between the BP and OP groups. Correlation and regression analysis were performed to clarify relationship between HRV differences and the borderline index (BI, a new concept defined by us, which is calculated as novelty seeking + harm avoidance – reward dependence). The HRV targets investigated included low frequency (LF) power, high frequency (HF) power, total power (TP), normalized LF (LF%), and LF/HF. No baseline HRV parameters showed any inter-group difference. The BP group had a significantly lower ?HF and a higher ?LF/HF than the OP group. The personality dimension, reward dependence, showed a negative correlation with ?LF/HF and ?LF%. BI was negatively correlated with ?HF and positively correlated with ?LF/HF and ?LF%.Borderline personality individuals show increased sympathetic activity and decreased parasympathetic activity compared to other personalities after taking methadone. The results support the hypothesis that there is an interaction between borderline personality and autonomic modulation.
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Simultaneous determination in hair of multiclass drugs of abuse (including THC) by ultra-high performance liquid chromatography-tandem mass spectrometry.

Filed under: Methadone Clinics

J Chromatogr B Analyt Technol Biomed Life Sci. 2012 May 5;
Di Corcia D, D’Urso F, Gerace E, Salomone A, Vincenti M

A simple procedure for the quantitative determination in hair samples of 13 common drugs of abuse or metabolites (morphine, 6-acetylmorphine, codeine, amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyethylamphetamine, benzoylecgonine, cocaine, buprenorphine, methadone and ?(9)-tetrahydrocannabinol) has been developed and fully validated. The analytes were extracted from the matrix by a simple overnight incubation with methanol at 55°C. An aliquot of the extract was directly injected into an ultra-high performance liquid chromatography system equipped with Waters Acquity UHPLC BEH C18 column (100mm×2.1mm, 1.7?m). The mobile phase eluted with a linear gradient (water/formic acid 5mM:acetonitrile; v:v) from 98:2 to 0:100 in 4.5min, followed by isocratic elution at 100% B for 1.0min. The flow rate was 0.6mL/min and the total run time was 8.0min including re-equilibration at the initial conditions. The compounds were revealed by a triple quadrupole mass spectrometer operating in the selected reaction monitoring mode. The absence of matrix interferents, together with excellent repeatability of both retention times and relative abundances of diagnostic transitions, allowed the correct identification of all analytes tested. The method proved linear in the interval from the limit of quantification to 5.0ng/mg (1.0ng/mg for ?(9)-tetrahydrocannabinol) with correlation coefficient values ranging from 0.9970 to 0.9997. Quantitation limits were below the cut-off values recommended by the Society of Hair Testing and ranged from 0.02 to 0.08ng/mg. Application of the present UHPLC-MS/MS procedure and instrumentation to hair analysis allows high sample-throughput, together with excellent sensitivity and selectivity, in workplace drug-screening controls and forensic investigations. These qualities, combined with minimal sample workup, make the cost of this screening affordable for most private and public administrations.
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Warren to finally consider proposal for methadone clinic

Filed under: Methadone Clinics

By Stephen Betts, BDN Staff WARREN, Maine — The long stalled proposal for a methadone clinic in Warren will be heard by the town planning board next week. The planning board has scheduled a meeting for 7 pm Thursday, May 31, at the Warren Community …
Read more on Bangor Daily News

Man held on 000 bail in robbery outside methadone clinic

Filed under: Methadone Clinics

By KATHRYN MARCHOCKI MANCHESTER — A man who assaulted and robbed a woman outside a local methadone clinic, then threatened her with what she believed was a handgun Tuesday morning, later was arrested in Raymond, police said. Bail was set at $ 75000 …
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