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Methadone Maintenance Program (methadone + maintenance_program)

Distribution by Scientific Domains

Medical Sciences	88%

Selected Abstracts

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

ADDICTION, Issue 6 2008
David M. Novick
ABSTRACT Aims Hepatitis C virus (HCV) infection is a common chronic complication of injection drug use. Methadone maintenance programs contain large numbers of patients infected with HCV. This paper reviews HCV infection with emphasis on the medical care of HCV-infected, or HCV and human immunodeficiency virus co-infected, patients on methadone or buprenorphine maintenance. Methods Literature searches using PubMed, PsycINFO and SocINDEX were used to identify papers from 1990,present on antiviral therapy for HCV in methadone maintenance patients and on liver transplantation in methadone maintenance patients. Results Injection drug use is the most significant risk factor for HCV infection in most western countries. The prevalence of HCV antibody is high in injection drug users (53,96%) and in patients enrolled in methadone maintenance programs (67,96%). Studies of antiviral therapy for HCV in methadone maintenance patients show rates of sustained virological response (SVR), defined as negative HCV-RNA 24 weeks after the end of treatment, of 28,94%. In studies with contrast groups, no significant differences in SVR between methadone and contrast groups were found. Excellent completion rates of antiviral therapy (72,100%) were found in five of six studies. There are many barriers to methadone maintenance patients' receiving antiviral therapy, and research on overcoming barriers is discussed. Liver transplantation has been successful in methadone maintenance patients but has not been utilized widely. Conclusion High quality medical care for all aspects of HCV infection can be provided to methadone maintenance patients. The literature supports the effectiveness of such services, but the reality is that most patients do not receive them. [source]

Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment Organizations

HEALTH SERVICES RESEARCH, Issue 3 2003
Peter D. Friedmann
Objectives This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment. Methods Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients. Results In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3). Conclusions Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs. [source]

Syringe exchange, injecting and intranasal drug use

ADDICTION, Issue 1 2010
Don C. Des Jarlais
ABSTRACT Objective To assess trends in injecting and non-injecting drug use after implementation of large-scale syringe exchange in New York City. The belief that implementation of syringe exchange will lead to increased drug injecting has been a persistent argument against syringe exchange. Methods Administrative data on route of administration for primary drug of abuse among patients entering the Beth Israel methadone maintenance program from 1995 to 2007. Approximately 2000 patients enter the program each year. Results During and after the period of large-scale implementation of syringe exchange, the numbers of methadone program entrants reporting injecting drug use decreased while the numbers of entrants reporting intranasal drug use increased (P < 0.001). Conclusion While assessing the possible effects of syringe exchange on trends in injecting drug use is inherently difficult, these may be the strongest data collected to date showing a lack of increase in drug injecting following implementation of syringe exchange. [source]

LC,ESI-MS/MS analysis for the quantification of morphine, codeine, morphine-3-,- D -glucuronide, morphine-6-,- D -glucuronide, and codeine-6-,- D -glucuronide in human urine

JOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 11 2005
Constance M. Murphy
Abstract A liquid chromatographic-electrospray ionization-tandem mass spectrometric method for the quantification of the opiates morphine, codeine, and their metabolites morphine-3-,- D -glucuronide (M-3-G), morphine-6-,- D -glucuronide (M-6-G) and codeine-6-,- D -glucuronide (C-6-G) in human urine has been developed and validated. Identification and quantification were based on the following transitions: 286 to 201 and 229 for morphine, 300 to 215 and 243 for codeine, 644 to 468 for M-3-G, 462 to 286 for M-6-G, and 476 to 300 for C-6-G. Calibration by linear regression analysis utilized deuterated internal standards and a weighting factor of 1/X. The method was accurate and precise across a linear dynamic range of 25.0 to 4000.0 ng/ml. Pretreatment of urine specimens using solid phase extraction was sufficient to limit matrix suppression to less than 40% for all five analytes. The method proved to be suitable for the quantification of morphine, codeine, and their metabolites in urine specimens collected from opioid-dependent participants enrolled in a methadone maintenance program. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Substance Abuse Treatment and Hospitalization among a Cohort of HIV-Infected Individuals with Alcohol Problems

ALCOHOLISM, Issue 3 2005
Anita Palepu
Background: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. Methods: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. Results: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7,1.5), whereas homelessness (AOR 2.3; 95% CI 1.5,3.6), injection drug use (AOR 1.7; 95% CI 1.0,2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00,1.05), CD4 cell count (AOR 0.999; 95% CI 0.998,1.00), and HIV RNA (AOR 1.1; 95% CI 1.0,1.2) were independently associated with increased odds of hospitalization over time. Conclusions: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals. [source]

Need for Medical and Psychosocial Services Among Injection Drug Users: A Comparative Study of Needle Exchange and Methadone Maintenance

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2002
Michael D. Stein M.D.
This study compares the prevalence of perceived and unmet needs of HIV-negative injection drug users (IDUs) not receiving drug treatment (n = 251) and those recruited from a methadone maintenance program (n = 312) in 1998. We studied self-reported needs for six community services: medical, mental health, housing, income assistance, alcohol treatment, and drug treatment. Respondents reported the highest levels of need for mental health and housing services. Ninety-four percent of out-of-treatment IDUs reported having at least one need compared to 62% of methadone clients (p < .001). Across all reported service needs, at least 69% of respondents in both cohorts reported their needs were unmet. While HIV-infected drug users receive assistance through the Ryan White CARE Act, these findings suggest that seronegative drug users may benefit from similar community service programs. [source]

Modified Directly Observed Therapy (MDOT) for Injection Drug Users with HIV Disease

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2002
Elinore F. McCance-Katz M.D., Ph.D.
Injection drug use is an important factor in the spread of HIV infection, and strategies to enhance adherence to HIV therapeutics are critically important to controlling viral transmission and improving clinical outcomes. To this end, the authors sought (1) to enhance adherence to highly active antiretroviral therapy (HAART) among methadone-maintained injection drug users (IDUs) using modified directly observed therapy (MDOT), and (2) to define interactions between methadone and HAART and the potential contribution of drug interactions to adherence and HIV outcomes in this population. Adherence was explored here through a pilot, unblinded, 24-week study in a methadone maintenance program in which simplified HAART (efavirenz and didanosine [once daily] and a second nucleoside [twice daily]) was administered 6 days/week by clinic staff to HIV-infected IDUs (n = 5) with their methadone. Evening doses of riboflavin-tagged nucleoside and one full day of medication weekly were given as take home doses. As a result of HAART administration, four of five participants with mean viral load at baseline of 105 copies/ml had undetectable viral load by 8 weeks of treatment (p = 043). Methadone area under the curve (AUC) decreased by 55% (p = 007) within 2 weeks of initiating this HAART regimen, and a mean methadone dose increase of 52%o was required. The authors conclude that MDOT is a promising intervention for the treatment of IDUs with HIV disease, though significant drug interactions must be monitored for carefully and rapidly addressed. [source]