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Methadone reduction treatment after a substitutive maintenance treatment still has a clinical interest in the care of patients with opioid addiction. Recent studies about agonist drugs and success in methadone detoxification have provided relevant information, but it is also interesting to explore the possible influence of other factors. The main goal of this research was to analyze the variables that can better predict achieving a zero dose of methadone. Three years monitoring of methadone detoxification in a sample of 81 outpatients treated at 16 clinics is presented. The findings suggest that agreement between the clinicstaff and the patient, low scores on perceived stress before starting dose reduction, drugs support and social care during the intervention are the group of variables with more advantages for achieving a zero dose of methadone. These results could facilitate a prognosis, guide clinicians in prescribing intervention, and improve procedures. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2010.07.009 Byline: Hayley Pinto, Vivienne Maskrey, Louise Swift, Daphne Rumball, Ajay Wagle, Richard Holland Keywords: Buprenorphine; Methadone; Maintenance; Treatment retention; Opiate dependence Abstract: This prospective patient-preference study examined the effectiveness in practice of methadone versus buprenorphine maintenance treatment and the beliefs of subjects regarding these drugs. A total of 361 opiate-dependent individuals (89% of those eligible, presenting for treatment over 2 years at a drug service in England) received rapid titration then flexible dosing with methadone or buprenorphine; 227 patients chose methadone (63%) and 134 buprenorphine (37%). Participants choosing methadone had more severe substance abuse and psychiatric and physical problems but were more likely to remain in treatment. Survival analysis indicated those prescribed methadone were over twice as likely to be retained (hazard ratio for retention was 2.08 and 95% confidence interval [CI] = 1.49-2.94 for methadone vs. buprenorphine), However, those retained on buprenorphine were more likely to suppress illicit opiate use (odds ratio = 2.136, 95% CI = 1.509-3.027, p < .001) and achieve detoxification. Buprenorphine may also recruit more individuals to treatment because 28% of those choosing buprenorphine (10% of the total sample) stated they would not have accessed treatment with methadone. Article History: Received 1 February 2010; Revised 19 July 2010; Accepted 22 July 2010

ABSTRACT Aims To identify dose-tapering strategies associated with sustained success following methadone maintenance treatment (MMT). Design Population-based retrospective cohort study. Setting Linked administrative medication dispensation data from British Columbia, Canada. Participants From 25 545 completed MMT episodes, 14 602 of which initiated a taper, 4183 individuals (accounting for 4917 MMT episodes) from 1996 to 2006 met study inclusion criteria. Measurements The primary outcome was sustained successful taper, defined as a daily dose ≤5 mg per day in the final week of the treatment episode and no treatment re-entry, opioid-related hospitalization or mortality within 18 months following episode completion. Findings The overall rate of sustained success was 13% among episodes meeting inclusion criteria (646 of 4917), 4.4% (646 of 14 602) among all episodes initiating a taper and 2.5% (646 of 25 545) among all completed episodes in the data set. The results of our multivariate logistic regression analyses suggested that longer tapers had substantially higher odds of success [12-52 weeks versus <12 weeks: odds ratio (OR): 3.58; 95% confidence interval (CI): 2.76-4.65; >52 weeks versus <12 weeks: OR: 6.68; 95% CI: 5.13-8.70], regardless of how early in the treatment episode the taper was initiated, and a more gradual, stepped tapering schedule, with dose decreases scheduled in only 25-50% of the weeks of the taper, provided the highest odds of sustained success (versus <25%: OR: 1.61; 95% CI: 1.22-2.14). Conclusions The majority of patients attempting to taper from methadone maintenance treatment will not succeed. Success is enhanced by gradual dose reductions interspersed with periods of stabilization. These results can inform the development of a more refined guideline for future clinical practice. [ABSTRACT FROM AUTHOR]

Aim: This study investigates factors influencing the severity of opiate withdrawal symptoms, focusing on the relationship between methadone dose and withdrawal severity among opiate-dependent in-patients receiving methadone detoxification. Methods: The sample comprised 48 opiate-dependent patients admitted to a specialist in-patient drug treatment service and withdrawn from opiates, using a 10-day methadone reduction schedule. The severity of withdrawal symptoms was assessed daily using the Short Opiate Withdrawal Scale. Results: Patients withdrawn from higher doses of methadone and those reporting higher levels of anxiety reported more severe withdrawal symptoms. No relationship was found between methadone dose and completion of detoxification or length of hospital stay. Conclusions: Although patients on higher doses of methadone reported more severe opiate withdrawal symptoms than patients on lower doses, the dose effect accounted for only a small percentage of the total variance. Nonetheless, the finding of a dose-response effect supports one of the basic principles of clinical practice during detoxification, namely the matching of the medication withdrawal schedule to the pre-admission opiate dose. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services. Randomized controlled study conducted from May 1995 to April 1999. Research clinic in an established drug treatment program. One hundred and seventy-nine adults with diagnosed opioid dependence. Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months. Total health-care costs and self-reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($7564 versus $6687; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions. Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to analyze the obstetric and neonatal impact of an opioid detoxification program during pregnancy, as well as to examine variables associated with successful opioid detoxification. Study Design: This is a retrospective cohort study of women electing inpatient detoxification and subsequently delivering at our hospital from Jan. 1, 2006, through Dec. 31, 2011. Detoxification was considered successful if women had no illicit drug supplementation at the time of delivery. Maternal characteristics were ascertained by chart review and analyzed for variables associated with success. Obstetric and neonatal outcomes were also assessed based on maternal success at delivery. Results: Of the 95 women during the study period with complete data, 53 (56%) were successful. There were no demographic or social risk factors identified associated with success. Women with successful detoxification at delivery had longer inpatient detoxification admissions (median 25 vs 15 days, P < .001) and were less likely to leave prior to completion of the program than women who had relapsed at delivery (9% vs 33%, respectively, P < .001). Infants of mothers who were successfully detoxified had shorter hospitalizations (median 3 vs 22 days, P < .001), lower maximum neonatal abstinence syndrome scores (0 vs 8.3, P < .001), and were less likely to be treated for withdrawal (10% vs 80%, P < .001). Conclusion: Opiate detoxification in pregnancy requires a significant time commitment and extended treatment, however, can be successfully achieved in compliant parturients. Importantly, maternal demographics and drug histories do not portend success, supporting continued opiate detoxification being offered to all women expressing intent. [Copyright &y& Elsevier]