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Fulltext The Opposing Roles of IVS2+691 CC Genotype and AC/AG Diplotype of 118A>G and IVS2+691G>C of OPRM1 Polymorphisms in Cold Pain Tolerance Among Opioid-Dependent Malay Males on Methadone Therapy

Zahari Z, Lee CS, Ibrahim MA, Musa N, Yasin MA, Lee YY, et al.

Pain Ther, 2015 Dec;4(2):179-96.
PMID: 26581429 DOI: 10.1007/s40122-015-0041-y

We recently reported that a majority of opioid-dependent Malay males on methadone therapy are cold pain sensitive. It is postulated that common OPRM1 polymorphisms may be responsible. This study investigated the association between 118A>G (dbSNP rs1799971) and IVS2+691G>C (dbSNP rs2075572) variants on cold pain responses among opioid-dependent Malay males on methadone maintenance therapy.

Matched MeSH terms: Methadone*
Fulltext Methadone toxicity in a poisoning referral center

Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi-Mood N, Gheshlaghi F, et al.

J Res Pharm Pract, 2013 Jul;2(3):130-4.
PMID: 24991620 DOI: 10.4103/2279-042X.122387

OBJECTIVE: Methadone poisoning can occur accidentally or intentionally for suicide or homicide purposes. The aim of this study was to evaluate the epidemiological and clinical manifestations of Methadone poisoning.
METHODS: A descriptive analytical study was performed from 2010 to 2012 in the poisoning emergency and clinical toxicology departments of Noor hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran). All patients with Methadone poisoning within this period of time were investigated. Different variables were recorded in a checklist.
FINDINGS: A total of 385 patients were studied. About 85.7% had ingested only Methadone and 14.3% had ingested other medications with Methadone. Mean ± standard deviation of the age was 32.1 ± 15 years (range: 1-90). Most of the patients were male (76.4%). Nearly 40% of the patients were narcotic addicts, 25.5% were addicts under surveillance of Methadone maintenance therapy centers and 34.5% were non-addicts. Intentional poisoning was observed in most of the patients (57.7%). Most of the patients had a low level of consciousness on admission (58.2%). Respiratory depression and hypotension was observed in 35.6% and 12.7% of the cases as the most common symptoms. Regarding vital signs, there was a significant difference in respiratory rate on admission among different evaluated groups (P = 0.02). Length of hospital stay was 18.79 ± 0.72 h (range: 4-240 h, median: 15 h). About 57 patients (25.8%) from the intentionally poisoned patients and 19 patients (12.3%) from the unintentionally poisoned patients had a history of psychiatric disorder (P = 0.001). Most of the patients survived without complications.
CONCLUSION: Addiction, age, gender, attempt to suicide and a history of psychiatric disorder were of the most important factors effective in Methadone poisoning, which should be considered in the public training and prevention of poisoning.
KEYWORDS: Methadone; overdose; poisoning; toxicity

Matched MeSH terms: Methadone/poisoning*
Fulltext Opioid dependence and substitution therapy: thymoquinone as potential novel supplement therapy for better outcome for methadone maintenance therapy substitution therapy

Adnan LH, Bakar NH, Mohamad N

Iran J Basic Med Sci, 2014 Dec;17(12):926-8.
PMID: 25859295

Methadone is widely being used for opioid substitution therapy. However, the administration of methadone to opioid dependent individual is frequently accompanied by withdrawal syndrome and chemical dependency develops. Other than that, it is also difficult to retain patients in the treatment programme making their retention rates are decreasing over time. This article is written to higlights the potential use of prophetic medicines, Nigella sativa, as a supplement for opioid dependent receiving methadone. It focuses on the potential role of N. sativa and its major active compound, Thymoquinone (TQ) as a calcium channel blocking agent to reduce withdrawal syndrome and opioid dependency.

Matched MeSH terms: Methadone*
Fulltext Pattern of QTc prolongation in Methadone Maintenance Therapy (MMT) subjects receiving different methadone dosages: A prospective cohort study

Mohamad N, Abdul Jalal MI, Hassan A, Abdulkarim Ibrahim M, Salehuddin R, Abu Bakar NH

Pak J Med Sci, 2013 Sep;29(5):1132-6.
PMID: 24353706

OBJECTIVES: This study aimed to compare the QTc interval between low and high dose methadone groups and evaluate the pattern of QTc variation.
METHODS: This is a prospective cohort study conducted from December 2010 till August 2011 at Malaysian University of Science's Hospital. Forty six subjects, grouped in high dose (>80mg) and low dose (<80mg) oral methadone, were followed-up at 4-weekly for QTc measurements. Relevant demographic and biochemical profiles were taken at intervals with concurrent QTc measurements.
RESULTS: No significant QTc differences between methadone dosage groups were found at Week 0 (434ms vs 444ms, p = 0.166) and week 8 (446.5ms vs 459ms, p = 0.076), but not at week 4(435ms vs 450ms, p = 0.029). However, there were significant associations between the groups with QTc prolongation at week 0 and 4 (OR 4.29(95% CI 1.01, 18.72) p=0.044 and OR 5.18 (95% CI 1.34, 20.06) p =0.013, respectively) but not at week 8 (OR 2.44 (95% CI 0.74, 8.01) p=0.139). On multivariate analysis, dose group was the sole significant factor for QTc prolongation for week 0 and 4 (p values 0.047 and 0.017, respectively), but not at week 8.
CONCLUSION: High-dose methadone group is more likely to develop prolonged QTc than low-dose group. However, such effects were inconsistent and occurred even during chronic methadone therapy, mandating judicious QTc and serum methadone monitoring.
KEYWORDS: High Dose; Low Dose; Methadone; QTc

Matched MeSH terms: Methadone*
Fulltext High-risk behaviours and concomitant medical illnesses among patients at methadone maintenance therapy clinic, Hospital Tengku Ampuan Afzan, Malaysia

Ramli M, Nora M, Zafri A, Junid M, Umeed A, Hajee M

Malays Fam Physician, 2009;4(2-3):77-82.
PMID: 25606168 MyJurnal

BACKGROUND: High prevalence of high-risk behaviours and concurrent medical illnesses among opioid drug users would influence the outcome of Methadone Maintenance Programme. It would also require a special medical attention to contain these issues.
OBJECTIVES: This study explored patients' characteristics and their high-risk behaviours in order to understand more about opioid dependent users in Malaysia.
METHODS: A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data.
RESULTS: Many of the patients were engaged in high-risk behaviours such as needle sharing, unsafe sex and criminal activities. A large number of the subjects had contracted blood-borne diseases such as HIV and hepatitis infections.
CONCLUSIONS: Education on the issue of medical and psychosocial complications related to high risk behaviours is essential. Medical professionals dealing with this group have to pay attention and update their knowledge on the medical issue.
KEYWORDS: Methadone therapy; high-risk behaviours; opioid dependence
Study site: Methadone clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia

Matched MeSH terms: Methadone*
Side Effects of Chronic Methadone Use in Opioid Addiction: A Scoping Review on Hematological Derangements

Khalid K, Anuar A, Ang WC, Jamaluddin R

Curr Drug Saf, 2023;18(2):167-174.
PMID: 35570535 DOI: 10.2174/1574886317666220514154931

BACKGROUND: Per oral methadone maintenance therapy [MMT] was introduced as part of harm reduction strategy to manage rising numbers of HIV infections caused by intravenous use of illicit drugs.
METHOD: We aim to review published articles related to the side effects of long-term methadone therapy, focusing on hematological derangements in human studies published between 1 January 2000 till 31 January 2021.
RESULTS: Our search databases include Web of Science, Scopus, and Medline. Our search yielded 971 articles, of which 55 articles were related to the effects of MMT on various organ systems: cardiovascular [n=12], respiratory [n=1], endocrine [n=10], central nervous system [n=12], neurobehavioral [n=10], gastrointestinal [n=1], and bone [n=1]. There were eight articles specifically related to the hematological side effects of chronic methadone therapy that include [i] immune system hyperactivation, [ii] reduced circulating lymphocytes, and [iii] increased blood viscosity.
CONCLUSION: In view of all foreseeable health risks seen with prolonged methadone therapy, pharmacological modulation is warranted to find a better substitute for managing patients with opioid dependence.

Matched MeSH terms: Methadone/adverse effects
Fulltext Assessing the Temporality Between Transitions onto Opioid Agonist Therapy and Engagement with Antiretroviral Therapy in a Cohort of HIV-Positive People Who Use Opioids Daily

Mitra S, Grant C, Nolan S, Mohd Salleh NA, Milloy MJ, Richardson L

AIDS Behav, 2022 Jun;26(6):1933-1942.
PMID: 34977956 DOI: 10.1007/s10461-021-03543-y

A robust evidence-base describes the beneficial association between opioid agonist therapy (OAT) and HIV-related outcomes among people living with HIV and opioid use disorder. While some evidence suggests the stabilizing effect of OAT on antiretroviral therapy (ART) treatment engagement, less is understood about the potential for an inverse relationship. We sought to examine the relationship between transitions in ART engagement and transitions onto OAT. We used data from a prospective cohort of people living with HIV who use drugs in Vancouver, Canada-a setting with no-cost access to ART and low or no-cost access to OAT among low-income residents. Restricting the sample to those who reported daily or greater opioid use, we used generalized linear mixed-effects models to estimate the relationships between our primary outcome of transitions onto OAT (methadone or buprenorphine/naloxone) and transitions (1) onto ART and (2) into ART adherence. Subsequent analyses assessed the temporal sequencing of transitions. Between 2005 and 2017, among 433 participants, 48.3% reported transitioning onto OAT at least once. In concurrent analyses, transitions onto ART were positively and significantly associated with transitions onto OAT. Temporal sequencing revealed that transitions into OAT were also positively and significantly associated with subsequent transitions onto ART. OAT's potential to facilitate the uptake of ART points to the continued need to scale-up low-threshold, client-centered substance use services integrated alongside HIV care.

Matched MeSH terms: Methadone/therapeutic use
Fulltext A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova

Dorgay CE, Bromberg DJ, Doltu S, Litz T, Galvez S, Polonsky M, et al.

Int J Drug Policy, 2022 Jun;104:103683.
PMID: 35417790 DOI: 10.1016/j.drugpo.2022.103683

BACKGROUND: Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this region that offers methadone within prisons, but uptake and post-release retention remains suboptimal. Screening, brief intervention, and referral to treatment (SBIRT) procedures are a potential implementation strategy to address this problem.
METHODS: From June 1, 2017 to March 3, 2018, we conducted a 2-stage SBIRT strategy in nine prisons and four pre-trial detention facilities in Moldova among incarcerated persons with opioid use disorder (OUD; N = 121) and within 90 days of release. Survey results were analyzed to evaluate the effect of the SBIRT strategy on the uptake of and post-release retention on methadone maintenance treatment (MMT).
RESULTS: Among the 121 screened with OUD, 27 were on MMT at baseline within the prison and this number increased to 41 after the two-step SBIRT intervention, reflecting a 51.9% increase over baseline. Eleven (78.6%) of the 14 participants that newly started MMT did so only after completing both SBIRT sessions. The brief intervention did not significantly improve knowledge about methadone but did improve attitudes towards it. Among the 41 participants who received methadone during this trial, 40 (97.6%) were retained 6 months after release; the one participant not retained was on methadone at the time of the intervention and had planned to taper off.
CONCLUSION: The SBIRT strategy significantly improved participant attitudes, but treatment initiation mostly occurred after completing both sessions, including soon after release, but remained low overall. Work within the Moldovan prison subculture to dispel negative myths and misinformation is needed to further scale-up OAT in Moldova.

Matched MeSH terms: Methadone/therapeutic use
Relationship between ABCB1 polymorphisms and serum methadone concentration in patients undergoing methadone maintenance therapy (MMT)

Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, et al.

Am J Drug Alcohol Abuse, 2016 09;42(5):587-596.
PMID: 27284701 DOI: 10.3109/00952990.2016.1172078

BACKGROUND: Methadone is a substrate of the permeability glycoprotein (P-gp) efflux transporter, which is encoded by the ABCB1 (MDR1) gene. Large interindividual variability in serum methadone levels for therapeutic response has been reported. Genetic variations in ABCB1 gene may be responsible for the variability in observed methadone concentrations.
OBJECTIVE: This study investigated the associations of ABCB1 polymorphisms and serum methadone concentration over the 24-hour dosing interval in opioid-dependent patients on methadone maintenance therapy (MMT).
METHODS: One hundred and forty-eight male opioid-dependent patients receiving MMT were recruited. Genomic deoxyribonucleic acid (DNA) was extracted from whole blood and genotyped for ABCB1 polymorphisms [i.e. 1236C>T (dbSNP rs1128503), 2677G>T/A (dbSNP rs2032582), and 3435C>T (dbSNP rs1045642)] using the allelic discrimination real-time polymerase chain reaction (PCR). Blood samples were collected at 0, 0.5, 1, 2, 4, 8, 12, and 24 hours after the dose. Serum methadone concentrations were measured using the Methadone ELISA Kit.
RESULTS: Our results revealed an association of CGC/TTT diplotype (1236C>T, 2677G>T/A, and 3435C>T) with dose-adjusted serum methadone concentration over the 24-hour dosing interval. Patients with CGC/TTT diplotype had 32.9% higher dose-adjusted serum methadone concentration over the 24-hour dosing interval when compared with those without the diplotype [mean (SD) = 8.12 (0.84) and 6.11 (0.41) ng ml-1mg-1, respectively; p = 0.033].
CONCLUSION: There was an association between the CGC/TTT diplotype of ABCB1 polymorphisms and serum methadone concentration over the 24-hour dosing interval among patients on MMT. Genotyping of ABCB1 among opioid-dependent patients on MMT may help individualize and optimize methadone substitution treatment.
Study site: Psychiatric Clinic, Hospital Universiti Sains Malaysia (HUSM), and other MMT clinics in Kelantan,
Malaysia

Matched MeSH terms: Methadone/blood*; Methadone/pharmacokinetics; Methadone/therapeutic use*
Fulltext Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Mohamad N, Bakar NH, Musa N, Talib N, Ismail R

Harm Reduct J, 2010;7:30.
PMID: 21167035 DOI: 10.1186/1477-7517-7-30

BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.

Matched MeSH terms: Methadone
Fulltext Associated risk factors to non-compliance to methadone maintenance therapy

Ramli M, Zafri AB, Junid MR, Hatta S

Med J Malaysia, 2012 Dec;67(6):560-4.
PMID: 23770945 MyJurnal

The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects' current employment and marital status. The programme's retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings.
Study site: Psychiatric clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia

Matched MeSH terms: Methadone*
Treating heroin addiction: bridging the past and future--a Malaysian experience

Robson N, Rashid R, Nazar M, Habil H

Asia Pac Psychiatry, 2015 Mar;7(1):121-5.
PMID: 23857876 DOI: 10.1111/j.1758-5872.2012.00194.x
Matched MeSH terms: Methadone/therapeutic use*
Fulltext Estimation of out-of-pocket costs of patients at the methadone maintenance therapy clinic in Malaysia

Manan MM, Ali SM, Khan MA, Jafarian S

Pak J Pharm Sci, 2015 Sep;28(5):1705-11.
PMID: 26408891

Out-of-pocket (OOP) payments may burden Methadone Maintenance Clinic patients. Since treatment is fully subsidized by the government, financial constraint might lead to patients being made to pay or be given incentive for inconvenience of therapy. This study thus evaluates the characteristic and commitment of methadone therapy patient's in terms of OOP cost, Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA) concept. This survey utilizes the questionnaire by Boris ova & Goodman (2003) on the OOP, WTP and WTA. The forty adult patient's selected medical records from year 2009-2011 were from an urban government methadone clinic. Subject's selection was by convenient sampling based on the predetermined criteria. Most were male (95%) and Malay (60%) was the predominant group. Patients were group into three income groups; ≤ RM1000, ≥ RM1000 -≤ RM2000 and ≥ RM3000. The average OOP cost per month was RM391.30 (s.d RM337.50), which is about 35% of employed patient's monthly income. The wide variation could be attributed by high inter-individual and significant differences between patients in terms of transport, times taken to clinic, cost per trip and weekly household income (p=<0.05). Patients with income of less than RM1000 showed the highest tendency to pay for treatment, asked for the least money for inconvenience and many are unwilling to accept any payments. These findings showed that WTP and WTA is less of a concern for patients in the low-income group. To conclude, OOP payment is not a treatment barrier for most of the urban MMT patients.

Matched MeSH terms: Methadone/therapeutic use*
Report: Demographic profiles and sleep quality among patients on methadone maintenance therapy (MMT) in Malaysia

Zahari Z, Siong LC, Musa N, Mohd Yasin MA, Choon TS, Mohamad N, et al.

Pak J Pharm Sci, 2016 Jan;29(1):239-46.
PMID: 26826835

Poor sleep quality was frequently reported by opioid dependence patients during methadone maintenance therapy (MMT). The study investigated a sample of patients on MMT to investigate the severity and prevalence of sleep problems in MMT patients. We evaluated sleep quality and disturbances of 119 Malay male patients from MMT clinics in Kelantan, Malaysia between March and July 2013 using the Pittsburgh Sleep Quality Index (PSQI)-Malay version. Patients' demographic, clinical data, past drug history and methadone treatment variables were recorded. Patients averaged 37.5 years of age (SD 6.79) and their mean age of first time illicit drug use was 19.3 years (SD 4.48). Their mean age of entering MMT was 34.7 years (SD 6.92) and the mean duration in MMT was 2.8 years (SD 2.13). The mean current daily dosage of methadone was 77.8 mg (SD 39.47) and ranged from 20 to 360 mg. The mean global PSQI score was 5.6 (SD 2.79) and 43.7% patients were identified as 'poor sleepers' (global PSQI scores >5). This study confirms the poor overall sleep quality among patients on MMT. The prevalence and severity of sleep problems in MMT patients should not be underestimated.

Matched MeSH terms: Methadone/therapeutic use*
Erectile dysfunction among patients on methadone maintenance therapy and its association with quality of life

Teoh JB, Yee A, Danaee M, Ng CG, Sulaiman AH

J Addict Med, 2017 Jan-Feb 6;11(1):40-46.
PMID: 27753719 DOI: 10.1097/ADM.0000000000000267

OBJECTIVES: Erectile dysfunction (ED) is a problem commonly encountered by patients on methadone maintenance therapy (MMT). This study aimed to assess the prevalence of ED among this group of patients along with its risk factors and association with quality of life (QOL).
METHODS: Male patients on MMT in a tertiary hospital in Malaysia were included in the study. A total of 134 patients with sexual partners were assessed for ED using the International Index of Erectile Function. Patients were assessed for substance use using Opiate Treatment Index (OTI) and depression using the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM). QOL was evaluated using World Health Organisation Quality of Life (WHOQOL)-BREF.
RESULTS: The prevalence of ED among patients on MMT was 67%, with 26.1% having mild ED, 30.4% having mild-to-moderate ED, 7.0% having moderate ED, and 17.2% having severe ED. Patients with depression were 4 times more likely to have ED compared with patients without depression, whereas increasing age significantly correlated with the severity of ED. Having ED predicted a poorer QOL in the social relationships domain.
CONCLUSION: Depression is highly associated with ED, which negatively influences the social aspect of QOL among patients on methadone maintenance therapy.
Study site: outpatient addiction psychiatric clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Methadone*
Fulltext Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia

Bazazi AR, Culbert GJ, Wegman MP, Heimer R, Kamarulzaman A, Altice FL

BMC Infect Dis, 2022 Nov 11;22(1):837.
PMID: 36368939 DOI: 10.1186/s12879-022-07804-6

INTRODUCTION: Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Maintenance with opioid agonist therapy (OAT) like methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison.
METHODS: This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n = 291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n = 64) and participant choice (n = 246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival.
RESULTS: Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5-89.4). Most deaths were of infectious etiology, mostly related to HIV. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6-3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5-2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0-1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1-3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7-1.0).
CONCLUSIONS: Postrelease mortality in this sample of men with HIV and OUD was extraordinarily high, and most deaths were likely of infectious etiology. No effect of prerelease methadone on postrelease mortality was observed, which may be due to study limitations or an epidemiological context in which inadequately treated HIV, and not inadequately treated OUD, is the main cause of death after prison release.
TRIAL REGISTRATION: NCT02396979. Retrospectively registered 24/03/2015.

Matched MeSH terms: Methadone/therapeutic use
Fulltext Methadone Maintenance Treatment for Opioid Dependents: a Retrospective Study

Khalid K, Ooi YT, Abdul Rashid Q, Mohammad Yusoff MZA, Jamaluddin R

East Asian Arch Psychiatry, 2022 Sep;32(3):47-50.
PMID: 36172721 DOI: 10.12809/eaap2214

OBJECTIVES: To determine the prevalence of continued illicit drug use among people enrolled in methadone maintenance treatment (MMT), the association between hepatitis C status and methadone dosage, and the predictors for illicit drug abstinence during MMT.
METHODS: Clinical records of active opioid dependents who underwent MMT between 1 January 2007 and 31 March 2021 in Hospital Tuanku Fauziah, Perlis, Malaysia were retrospectively reviewed. Data collected included baseline demographics, history of illicit drug use, temporal trend in methadone dosage modulation, and co-use of illicit drugs during the MMT.
RESULTS: A total of 87 patients (mean age, 43.9 ± 8.33 years) were included. Their mean duration of involvement in MMT was 7.8 ± 3.69 years. The most commonly used drug was heroin (88.5%), followed by kratom (51.7%). Between 2019 and 2021, 61 (70.1%) patients had ceased abusing opioid, but 51 (58.6%) patients continued using any of the illicit drugs. Methamphetamine and amphetamine co-use was most common (n = 12, 37.5%). Hepatitis C status was not associated with the current methadone dose (U = 539.5, p = 0.186) or the highest dose required (t = -0.291, df = 74, p = 0.772). No predictor for illicit drug abstinence during MMT was identified. Methadone dose positively correlated with frequency of defaulting treatments (r = 0.22, p = 0.042).
CONCLUSION: Among our patients, MMT for opioid dependents cannot sufficiently curb illicit drug use, and there is a shift toward stimulants abuse.

Matched MeSH terms: Methadone/therapeutic use
Fulltext Factors affecting addiction severity index (ASI) among clients enrolled in methadone maintenance treatment (MMT) program in Myanmar

Tun S, Vicknasingam B, Singh D

Harm Reduct J, 2021 08 05;18(1):84.
PMID: 34353331 DOI: 10.1186/s12954-021-00523-2

BACKGROUND: Opioid substitution with methadone maintenance treatment (MMT) is shown to reduce illicit opioid use and renew social functioning. Understanding factors that undermine clients' social functioning during MMT treatment is vital for improving treatment compliance and quality of life.
METHOD: A total of 210 respondents who were already enrolled in a formal MMT program in Myanmar were recruited from five cities through stratified random sampling for this cross-sectional study. The addiction severity index (ASI) was used to objectively assess respondents social functioning in the last 30 days. Higher ASI scores denote poorer social functioning.
RESULT: Respondents total ASI scores in the respective domains were: employment (47.4%), alcohol (44.4%), drug use (7.2%), legal (49.2%) and social-family relationship (10.7%). Those reported to have never injected drugs in the last 30 days had lower ASI total scores than those who reported injection drug use (p = 0.01). After identifying the differences in ASI total scores, we found there were significant associations in the clients' hepatitis C status, age category, frequency of heroin injection, quality of life score, marital status, current leisure status with family/friend, current history of injection in the last 30 days, income status, satisfaction with current marital status, as well as reported drug and alcohol use (p

Matched MeSH terms: Methadone/therapeutic use
Fulltext Relationship between cold pressor pain-sensitivity and sleep quality in opioid-dependent males on methadone treatment

Zahari Z, Lee CS, Tan SC, Mohamad N, Lee YY, Ismail R

PeerJ, 2015;3:e839.
PMID: 25870765 DOI: 10.7717/peerj.839

Aim. Poor sleep quality due to pain has been reported among opioid-dependent male patients on methadone maintenance therapy (MMT) but objective pain data are lacking. This study aimed to investigate the rate of pain-sensitivity using cold pressor test (CPT) and the relationship between pain-sensitivity and sleep quality in this population.
Methods. A total of 168 male participants were included into the study. Objective pain-tolerance was evaluated at 0 h and at 24 h after the first CPT. Malay version of the Pittsburgh Sleep Quality Index (PSQI) and the subjective opiate withdrawal scale (SOWS) questionnaires were administered to evaluate the quality of sleep and withdrawal symptoms, respectively.
Results. The mean age of study participants was 37.22 (SD 6.20) years old. Mean daily methadone dose was 76.64 (SD 37.63) mg/day, mean global PSQI score was 5.47 (SD 2.74) and mean averaged SOWS score was 5.43 (SD 6.91). The averaged pain-tolerance time ranged from 7 to 300 s with a mean time of 32.16 (SE 2.72) s, slightly below the cut-off score of 37.53 s. More specifically, 78.6% (n = 132) of participants were identified as pain-sensitive (averaged pain-tolerance time ≤37.53 s), and 36 (21.4%) participants were pain-tolerant (averaged pain-tolerance time >37.53 s). The pain-sensitive group reported poorer sleep quality with mean (SD) PSQI of 5.78 (2.80) compared with the pain-tolerant group with mean (SD) PSQI of 4.31 (2.18) (p = 0.005). With analysis of covariance, pain-sensitive group was found to have higher global PSQI scores (adjusted mean 5.76, 95% CI 5.29; 6.22) than pain-tolerant participants (adjusted mean 4.42, 95% CI 3.52; 5.32) (p = 0.010).
Conclusions. Majority of opioid-dependent male patients on methadone treatment are pain-sensitive with CPT. Poor sleep quality is associated with cold pressor pain-sensitivity. Pain and sleep complaints in this male population should not be overlooked.
Study site: Hospital Universiti Sains Malaysia (HUSM) and other MMT clinics (Kota Bharu, Pasir Mas, Pasir Puteh and Bachok), Kelantan, Malaysia

Matched MeSH terms: Methadone
Fulltext The first methadone programme in Malaysia: overcoming obstacles and achieving the impossible

Gill, Jesjeet Singh, Ahmad Hatim Sulaiman, Mohd Hussain Habil

ASEAN Journal of Psychiatry, 2007;8(2):64-70.
MyJurnal

Objectives: To determine the best possible programme that suits our local setting, to determine the average dose required, and to determine possible problems that can arise from implementing such a programme locally and how best to address them. Methods: The inclusion criteria were those above 18, a positive urine test, the presence of a supportive carer and willing to engage in the programme. Methadone was initiated and observations relating to dose, adverse events, relationship with carers, work performance, crime and high risk behaviours were monitored for 18 weeks. Results: Two thirds of the 45 subjects completed the trial over the 18 week period. No significant adverse events occurred and improvement in relationship with carers and work performance were noted with reduction in crime and high risk behaviours. Conclusion: Methadone is a safe and effective drug that can be used in the local Malaysian setting.

Matched MeSH terms: Methadone

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