A Medical Treatment for Diacetylmorphine (Heroin) Addiction

Dole, Vincent P.; Nyswander, Marie

doi:10.1001/jama.1965.03090080008002

Cited by 1,059 publications

(220 citation statements)

References 1 publication

Supporting

Mentioning

203

Contrasting

Unclassified

Order By: Relevance

“…Methadone maintenance treatment (MMT), a chronic treatment for opiate users [3], has been used for pharmacotherapy of heroin dependence since the mid-1960s [4], and contributes to a reduction in drug use, drug-injecting behaviors, drug-related criminal behaviors, unprotected sexual behaviors, human immunodeficiency virus (HIV) infections, and overdose deaths, and improves psychiatric comorbidity [5,6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance Treatment Program before They Drop Out against Medical Advice? A 12-Month Follow-Up Study

Wang

Wu²,

Lin³

et al. 2012

Eur Addict Res

View full text Add to dashboard Cite

Aim: Little is known about whether heroin-dependent individuals receiving methadone maintenance treatment (MMT) who were discharged involuntarily and against medical advice (DAMA) get benefits before they left. The aims of this 12-month follow-up study were to examine whether the effects of MMT on depressive symptoms, heroin dependence and quality of life (QOL) are different among the non-DAMA group, the DAMA group, and the involuntarily discharged group, as well as the time effect of receiving MMT on changes in these three outcome indicators. Method: A total of 266 individuals receiving MMT were divided into the non-DAMA group, the DAMA group, and the involuntarily discharged group. Participants were interviewed at baseline and at 3, 6, 9, and 12 months of treatment for levels of depressive symptoms, heroin dependence and QOL. Results: The levels of depressive symptoms, heroin dependence and QOL in all three groups improved after receiving MMT for 3 months and the improvement was maintained during the MMT period. There were no significant differences in the three outcome indicators among the three groups. Conclusion: The results support the concept that heroin-dependent individuals benefit from MMT, even if they do not want to stay in the program or drop out involuntarily.

show abstract

Section: Introductionmentioning

confidence: 99%

Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance Treatment Program before They Drop Out against Medical Advice? A 12-Month Follow-Up Study

Wang

Wu²,

Lin³

et al. 2012

Eur Addict Res

View full text Add to dashboard Cite

show abstract

“…Since methadone maintenance therapy (MMT) was introduced [1], many studies have been conducted to establish the pharmacokinetics of methadone. Unfortunately they have not led to a general consensus with regard to well-defined dosage schedules related to clinical and therapeutic efficacy.…”

mentioning

confidence: 99%

Pharmacokinetics of methadone and its primary metabolite in 20 opiate addicts

Vos

Geerlings

Brink³

et al. 1995

Eur J Clin Pharmacol

View full text Add to dashboard Cite

In a closed metabolic ward the pharmacokinetics of methadone and its primary metabolite (EDDP) were studied in 20 long-term opiate addicts. After administration of the daily oral dose of methadone HC1 (mean 60 rag, range 10-225 rag) blood samples were taken and analysed, using a newly developed high-performance liquid chromatography (HPLC) method. The steady-state plasma concentrations of the 20 subjects varied from 65-630 ng'ml -~ and from 5 to 55 ng'm1-1, whereas the peak concentrations were 124-1255 ng.m1-1 and 10 301 ng'ml -~ for methadone and EDDR respectively. The calculated ratios between the area under the curve (AUC(0_24 h)) for methadone and the AUC(0_24 h) for EDDP varied from 5.9 to 44.6, indicating interindividual differences in metabolic activity. In 19 out of 20 subjects the pharmacokinetics of methadone are best described using a two-compartment model. The mean body clearance was 1.64 ml.min-l.kg -~, whereas the mean elimination rate constant (/~) and plasma half-life (t,/fi) were 0.026'h -1 (range 0.013-0.053"h -~) and 31.2 h (range 13-53 h), respectively. Differences of gender were also found. A poor correlation was found between the methadone dose and the steady-state level. A much better correlation was found between the normalized steady-state level and the body clearance.Since methadone maintenance therapy (MMT) was introduced [1], many studies have been conducted to establish the pharmacokinetics of methadone. Unfortunately they have not led to a general consensus with regard to well-defined dosage schedules related to clinical and therapeutic efficacy. This might be explained in part by the very divergent results of most of the studies performed so far. For example, plasma half-lives of methadone in tolerant subjects under MMT have varied from 19 h [2] to even 75 h [3]. Both studies were performed in closed metabolic wards. The same variability has applied for bioavailability, which has ranged from 36% to 106% (mean 87%) among 12 tolerant opiate addicts [4], also in a closed metabolic ward. Another study revealed a mean bioavailability of 79% (range 41-99%) [5]. Furthermore, there has been no consensus as to whether the disposition of methadone follows a one-[6-8] or a two- [4,5,9] compartment model. However, most of these studies were performed under divergent, hardly comparable circumstances. The pharmacokinetics in non-tolerant ("naive") subjects might differ from those in tolerant subjects [10,11]. Also short-term treatment might give different results from long-term (steady-state) treatment [12,13]. However, it seems that determinations of plasma methadone in outdoor addicts show wider scatters in elimination half-lifes than those performed in closed metabolic wards: 17.8-63.8 h [8] and 18.9-43 h [2], respectively.The metabolism of methadone has been studied intensively. Many metabolites have been traced and identified in human urine [14,15]. Nevertheless essential knowledge about the formation and disposition of the major metabolite of methadone, EDDP (1,5-dimethyl-3,3-diphenyl-2-eth...

show abstract

“…Starting from the pioneer 22 patients study of Done and Nyswander, which first demonstrated in 1965 that the use of methadone is a safe and effective way to clinically manage heroin addiction, 16 all three substitutes mentioned earlier have been/ are submitted to extensive clinical trials and other forms of research to test their safety and effectiveness levels. To date, the research has demonstrated ample safety margins with no harm attributable to the medically prescribed substitute and remarkable levels of effectiveness regarding different outcome measures (reduction of severity of addiction, criminality levels and streetacquired heroin, social adjustment improve ment, cost-effectiveness and so on).…”

Section: Providing Users With a Substance Like That Which Created Thementioning

confidence: 99%

The Ethics in Substitution Treatment and Harm Reduction. An Analytical Review

Aceijas

2012

Public Health Rev

View full text Add to dashboard Cite

The ethics of opiate substitution treatment (OST) modalities for heroin addiction have been abundantly criticised but also have equally strong supporters. This analytical review addresses three main arguments against such treatments: 1) the social nature of the issue involves a misuse of the medical care; 2) the aim is one of social control (as opposed to a "cure") and therefore is a perversion health care; and 3) prescribing the very substance (or a substitute) that caused the addiction is ethically questionable. Additionally, the generic criticism against the philosophical/ theoretical framework under which they operate, "harm reduction" (HR) as an operational goal of therapy, is also addressed here.A summary review of the history of addiction supports the argument that, indeed, drug addiction "as a problem" was socially created. Equally clear is that one of the aims of OST and all drug-addition treatments is the social control of individual behaviours. However, neither of these two aspects justifies refusal to provide health and social care. OSTs are legitimate therapeutic options because they comply with the four principles of bioethics-autonomy, nonmaleficence, beneficence and justice. The argument that such treatments and the HR approach, in general, align with the principle of consequentialism-the aim justifies the means-and therefore is ethically questionable is a disingenuous criticism. Consequantialism is based in the implicit assumption that harms are accepted to reach certain objectives as the lesser of two evils. OSTs have been extensively proven as to their safety with benefits margins both at the individual (retention, reduction of illicit drug use and better social adjustment) as well as at the population levels (e.g., HIV incidence reduction). Heroin-substitution based treatment is the latest case of moral resistance to provide patients with the most effective option in spite of sound evidence on its effectiveness and safety. As in other cases of spurious resistance to public health and medical innovations, it is only a matter of time and endurance until such treatments are fully integrated among standard therapeutic options for heroin dependent individuals.

show abstract

A Medical Treatment for Diacetylmorphine (Heroin) Addiction

Cited by 1,059 publications

References 1 publication

Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance Treatment Program before They Drop Out against Medical Advice? A 12-Month Follow-Up Study

Can Heroin-Dependent Individuals Benefit from a Methadone Maintenance Treatment Program before They Drop Out against Medical Advice? A 12-Month Follow-Up Study

Pharmacokinetics of methadone and its primary metabolite in 20 opiate addicts

The Ethics in Substitution Treatment and Harm Reduction. An Analytical Review

Contact Info

Product

Resources

About