Withdrawal from methadone maintenance treatment. Reasons for not trying to quit methadone

Twelve-month Treatment Retention and Associated Factors: A Comparison of 2 Medically Assisted Therapy Clinics in Dar es Salaam, Tanzania

OBJECTIVES

Retention in methadone maintenance treatment is instrumental in achieving better treatment outcomes. In this study, we compared 2 medication-assisted treatment (MAT) clinics in Dar es Salaam, Tanzania with respect to patient characteristics, outcomes, and factors that predict 12-month treatment retention.

METHODS

This retrospective registry-based cohort study utilized data collected for routine clinical and program monitoring at 2 sites, Mwananyamala and Muhimbili MAT clinics. Cumulative retention in treatment was calculated using life tables. The analysis of treatment retention predictor variables used both Kaplan-Meier and Cox proportional hazard analyses.

RESULTS

We examined the socio-demographic and program-related characteristics of 362 (181 from each clinic) patients. Twelve-month treatment retention was higher at Mwananyamala (73%) than Muhimbili (64%) MAT clinic, but the difference was not significant. In both clinics, a higher methadone dose (>60 mg) significantly predicted treatment retention (P < 0.05). Being employed and traveling an average short distance (<5 km) from home to clinic significantly increased the likelihood of remaining in treatment in Muhimbili MAT clinic (P  < 0.05) only.

CONCLUSIONS

A methadone dose of 60 mg and above was associated with longer retention in treatment. At 1 clinic in a denser and more central location, employment and a short travel distance from home to clinic were associated with longer tenure in treatment. These findings have potential implications for clinical practice, research, and scaling up MAT services in Tanzania.

GRK5 Is Associated with the Regulation of Methadone Dosage in Heroin Dependence

Background

There is no countable biomarker for opioid dependence treatment responses thus far. In this study, we recruited Taiwanese methadone maintenance treatment patients to search for genes involving the regulatory mechanisms of methadone dose by genome-wide association analyses.

Methods

A total of 344 Taiwanese methadone maintenance treatment patients were included in a genome-wide association study. The involvement of GRK5 in opioid dependence was then further confirmed by gene expression study on lymphoblastoid cell lines derived from 3 independent age- and gender-matched groups: methadone maintenance treatment patients, medication-free former heroin abusers, and normal controls.

Results

The results indicated that GRK5, the gene encoding an enzyme related to μ-opioid receptor desensitization, is associated with methadone dose by additive model of gene-based association analysis (P=6.76×10-5). We found that 6 of the 55 single nucleotide polymorphisms from the genome-wide genotype platform and 2 single nucleotide polymorphisms from the 29 additionally selected single nucleotide polymorphisms were significantly associated with methadone maintenance dose in both genotype and allele type (P ≤ .006), especially in patients who tested negative in the urine morphine test. The levels of GRK5 gene expression were similar between methadone maintenance treatment patients and medication-free former heroin abusers. However, the normal controls showed a significantly lower level of GRK5 gene expression than the other groups (P=.019).

Conclusions

The results suggested an important role for GRK5 in the regulatory mechanisms of methadone dose and course of heroin dependence.

Predictors of One-Year Retention in Methadone Maintenance Treatment (MMT) in Iran, Rafsanjan

BACKGROUND

Retention in treatment is a key factor to the success of methadone maintenance treatment (MMT) and considered an important measure in evaluation of treatment effectiveness.

OBJECTIVES

This study aimed to investigate the retention rate and predictors of retention in MMT in Rafsanjan.

PATIENTS AND METHODS

This was a historical cohort study. A total of 1396 patients admitted between March 2011 and March 2012 in 16 MMT clinics (13 private and 3 state clinics) in Rafsanjan, entered the study and their retention rate was examined for one year. The patients' data abstracted from their medical records using checklists and collected by clinics' staff. Data analyses were performed using SPSS 15.0 and SAS 9.1. Kaplan-Meier method and Cox proportional hazards model were used to determine the retention rate and identify predictors of retention, respectively.

RESULTS

The mean age of 1396 patients was 37.65 ± 10.77 years and most patients were men (93.8%). The mean and median of retention duration were 193.22 ± 3.83 and 153 ± 9.54 days, respectively. Three-month and one-year retention rates were 66.0% and 34.4%, respectively. Predictor variables of one-year retention in Cox proportional hazards model were high methadone dosage, polysubstance abuse and treatment under state clinics.

CONCLUSIONS

In this study, retention rate was lower compared to previous studies from other countries. The results suggested that program related factors are better predictors of retention than individual related ones.

Predictive factors for treatment retention in methadone programs in Indonesia

This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The sample consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client's belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses.

The first 38 methadone maintenance treatment patients in Stockholm: 15-year follow-up with a main focus on detoxification from methadone

BACKGROUND/AIMS

The present study investigated the first 38 methadone maintenance treatment (MMT) patients in Stockholm. The aim was: (i) to investigate the possible predictive factors for successful treatment termination, and (ii) the long-term outcome effects and life situation of MMT patients and those who terminated the treatment.

METHODS

The patients were interviewed at the start and approximately 15 years later, and divided into four groups: (1) no withdrawal attempts, (2) forced to stop the treatment, (3) successful tapering and (4) non-successful tapering.

RESULTS

The predictive factor found that Group 1 showed a lower life quality compared with Groups 3 and 4. Fifteen years later, the life situations of Groups 3 and 4 were significantly more stable. Also the subjective well-being in Group 3 was significantly higher. Over all, Group 2 showed significantly more illicit drug use compared with Group 3. The social life situation was significantly improved for all patients during the 15 years.

CONCLUSION

This study confirms our earlier findings that the ultimate goal of MMT for the motivated patients with good progress should be an opiate-free life. The life situation and subjective well-being seems to be higher after successful termination of MMT.

"Should I stay or should I go?" Coming off methadone and buprenorphine treatment

BACKGROUND

This study aimed to investigate patient perspectives regarding coming off maintenance opioid substitution treatment (OST). The study explored previous experiences, current interest and concerns about stopping treatment, and perceptions of how and when coming off treatment should be supported.

METHODS

A cross-sectional survey was used. Participants were 145 patients receiving OST at public opioid treatment clinics in Sydney, Australia.

RESULTS

Sixty-two percent reported high interest in coming off treatment in the next 6 months. High interest was associated with having discussed coming off treatment with a greater number of categories of people (OR=1.72), not citing concern about heroin relapse (OR=3.18), and shorter duration of current treatment episode (OR=0.99). Seventy-one percent reported previous withdrawal attempts and 23% had achieved opioid abstinence for ≥3 months following a previous withdrawal attempt. Attempts most commonly involved jumping off (59%), and doctor-controlled (52%) or self-controlled (48%) gradual reduction. For future attempts respondents were most interested in doctor-controlled (68%) or self-controlled (41%) gradual reduction. Concerns regarding coming off treatment included withdrawal discomfort (68%), increased pain (50%), and relapse to heroin use (48%).

CONCLUSION

While some patients may require lifetime maintenance, the issue of coming off treatment is important to many patients and should be discussed regularly throughout treatment and where appropriate supported by a menu of clinical options.