A Meta-Analysis of Retention in Methadone Maintenance by Dose and Dosing Strategy
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Objective: To estimate, via meta-analysis, the influence of different methadone dose ranges and dosing strategies on retention rates in methadone maintenance treatment (MMT). Methods: A systematic literature search identified 18 randomized controlled trials (RCTs) evaluating methadone dose and retention. Retention was defined as the percentage of patients remaining in treatment at a specified time point. After initial univariate analyses of retention by Pearson chi-squares, we used multilevel logistic regression to calculate summary odds ratios (ORs) and 95% confidence intervals for the effects of methadone dose (above or below 60 mg/day), flexible vs. fixed dosing strategy, and duration of follow-up. Results: The total number of opioid-dependent participants in the 18 studies was 2831, with 1797 in MMT and 1034 receiving alternative mediations or placebo. Each variable significantly predicted retention with the other variables controlled for. Retention was greater with methadone doses ≥ 60 than with doses < 60 (OR: 1.74, 95% CI: 1.43–2.11). Similarly, retention was greater with flexible-dose strategies than with fixed-dose strategies (OR: 1.72, 95% CI: 1.41–2.11). Conclusions: Higher doses of methadone and individualization of doses are each independently associated with better retention in MMT.Keywords:
Retention rate
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Abstract Attitudes of opioid users toward methadone maintenance were studied using semistructured field interviews. One hundred and sixty-one heroin and speedball users in San Antonio, Texas, were interviewed between 1989 and 1992. Users were classified according to whether or not they had ever been on methadone maintenance. Opioid users who had never been on methadone maintenance were more likely to express a negative attitude toward methadone maintenance than users who had been on it (50% versus 30%). Sources of negative attitudes fell into the following categories: (1) general societal disapproval of addictive drugs, including methadone; (2) prior experience with 12 Step groups or abstinence-based treatment programs; (3) previous forced rapid detoxification from methadone in jail; and (4) observation of methadone maintained peers who continued to use drugs. Very few respondents reported adverse effects from methadone itself as a source of negative attitudes. Sources of positive attitudes included: (1) prior successful treatment with methadone; and (2) observation of methadone patients who stopped using drugs.
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Objective:To summary methadone dosage introduction and regulation for patients on methadone maintenance treatment(MMT). Methods:We analyzed 566 medical records of patients on MMT from June 20,2005 to December 31,2006 at the MMT clinic of Liuzhou Disease Prevention and Control Center(CDC). Results:Initial dosage and superaddition on the first day, dosage and superaddition on the second day were established according to the quantity of heroin use by the patients. However the initial dosage for all patients was less than 50 mg and the dose added for the following day less than 30 mg. The lowest dosage for maintenance was 10-35 mg.Conclusion:Adoption of this method for methadone dosage introduction and regulation for patients on MMT is safe and suitable at MMT clinics, which is worth recommendation.
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Introduction: Methadone has been an essential medication in the treatment of opioid addiction worldwide.Aim: To discuss dosing considerations related to different methadone programs.Method: A search was performed the Ovid (all resources) including: Medline, Cochrane, and EMBASE databases using the following terms: methadone dose, methadone optimization, and methadone adequacy. We compared and assessed the eligible studies with respect to the global guidelines for methadone dosing.Result: 103 different resources have been discussed and presented in the context of methadone dosing. Types of related concerns included: impact of dose on type of the program, dose induction, maintenance dose, dose in case of adverse events, doses in patients with different ethnicities, doses in males and females and dose and compliance.Conclusion: Although there is no global consensus on methadone dosing, there is a good similarity amongst the guidelines and published data on the general practical dosing regimens. Go-Slow is the most commonly used technique, and described to be the safest, too.
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Objective:To research on the dependence of methadone in different populations.Methods:First,doctors identify patients' initial dose,and then gradually reduce the methadone dose,until she reached a low dose of steady state,then do t test through the different crowd's methadone maintenance treatment clinical data to obtain the difference.Results:After sufficient quantities maintenance therapy,many of the patients can be tapered to low doses(20ml / day),even withdrawal.In addition,obtained that different people have different dependence of methadone.Conclusion:①Female patients can be reduced to a lower dose than male patients;② Younger can be reduced to lower than older ones;③The less drug use fixed number of year,the lower methadone reduced to.The upper conclusions can used to guide doctor's medication.
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Methadone Maintenance Treatment (MMT) is among the most widely studied treatments for opiate dependence with proven benefits for patients and society. When misused, however, methadone can also be lethal. The issue of methadone diversion is a major concern for all MMT programs. A potential source for such diversion is from those MMT patients who receive daily take home methadone doses. Using a reverse phase high performance liquid chromatography method, seven of the nine patients who were randomly selected to have all of their remaining methadone take home doses (within a 24 hour period) analyzed, returned lower than expected quantities of methadone. This finding suggests the possibility that such patients may have tampered with their daily take home doses. Larger prospective observational studies are clearly needed to test the supposition of this pilot study.
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To identify medication adherence and its influencing factors among patients of 14 methadone maintenance treatment (MMT) clinics in Xi'an, China.Data were obtained from the National AIDS Information System-Community Methadone Maintenance Treatment. All patients registered in the system were not permitted to take methadone at home without professionals' supervision. Medication adherence was assessed using categorical (ie, dropout or retained) and continuous (ie, treatment time, methadone use time, and percentage of methadone use days) variables. Percentages of methadone use days of >90%, 50% to 90%, or <50% indicated good, moderate, and poor adherence, respectively. Multivariate Cox stepwise regression analysis was used to identify the influencing factors.Of the 10,398 patients, 52.2% had dropped out of MMT by December 31, 2013, whereas only 11.8% regularly visited the clinic for daily methadone (ie, >90% methadone use days) during a certain period. Protective factors were older age (>30 years); female sex; having no contact with peer drug users over the past month; no needle-sharing experience; a negative initial morphine urine test; and a higher average daily methadone dose (>20 mg) (P < 0.05). Risk factors were answering "others" for marital status; being employed; having a lack of stable income; not living with family; answering "others" for drug use type; frequently engaging in unauthorized drug use during MMT; no readmission; long travel times to the MMT clinic (>30 minutes); having no convenient MMT service time; and being dissatisfied with MMT service (P < 0.05).Based on our findings, multimodal intervention and management programs can be developed to improve poor medication adherence among the MMT patient population.
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To assess the long-term effects of methadone maintenance, we compared the 10-year outcomes of 95 chronic opioid users who spent at least one cumulative year on methadone with those of 77 chronic opioid users who spent less than one cumulative year on methadone. All subjects were men and 90% were Mexican-American. The two groups were similar on 12 of 15 background variables. During the 10-year period, the methadone group had a cumulative mean of 54 months on methadone, while the comparison group had a cumulative mean of only 2 months on methadone. On social performance, as measured by months employed and months institutionalized, the methadone group did significantly better than did the comparison group. On months of voluntary abstinence, however, the comparison group did significantly better than did the methadone group. The mean of the comparison group, 36 months, was three times greater than that, 12 months, of the methadone group. At the end of the 10-year period, 26% of the comparison group but only 7% of the methadone group had been in continuous voluntary abstinence for 3 years or longer. Methadone maintenance for 1 year or longer was inversely related to abstinence during and at the end of the 10 years. This finding seems consistent with the hypothesis that methadone maintenance for 1 year or longer impedes eventual recovery from opioid dependence. For many patients, however, the benefits of prolonged maintenance could outweigh the possible cost of diminished likelihood of eventual recovery.
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