Change in Quality of Life and Its Predictors in Heroin Users Receiving Methadone Maintenance Treatment in Taiwan: An 18-Month Follow-Up Study

Wang, Pengwei; Wu, Hung‐Chi; Yen, Chia‐Nan; Yeh, Yi-Chun; Chung, Kuan-Sheng; Chang, Hsun-Cheng; Yen, Cheng‐Fang

doi:10.3109/00952990.2011.649222

Cited by 70 publications

(77 citation statements)

References 16 publications

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“…In the literature, trajectories of health outcomes under MMT were consistent. In Taiwan, Malaysia, China, the health-related quality of life of MMT patients, as measured using the WHOQOL-BREF -a generic health profile developed by the World Health Organization, increases gradually up to two year of MMT (Karow et al, 2010;Musa et al, 2012;Wang et al, 2012;Xiao, Wu, Luo, & Wei, 2010). Similarly, in this study, we found that the improvement in health utility that was attributable to MMT was independent on the length of taking MMT.…”

Section: Discussionsupporting

confidence: 66%

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Opioid pharmacotherapy: Treatment, regimes, constructions and control

Neale¹

2013

International Journal of Drug Policy

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Section: Discussionsupporting

confidence: 66%

“…Impacts of MMT programs in Asia have been evaluated in longitudinal studies (Musa, Abu Bakar, & Ali Khan, 2012;Tran et al, 2012e, 2012g;Wang et al, 2012;Xing et al, 2012;Yen, Wang, Wang, Chen, & Chang, 2011). The primary measures of health outcomes basically included changes in drug use behaviours and health-related quality of life (HRQOL).…”

Section: Discussionmentioning

confidence: 99%

Opioid pharmacotherapy: Treatment, regimes, constructions and control

Neale¹

2013

International Journal of Drug Policy

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“…ethadone, a synthetic opioid used as an analgesic agent (Leimanis et al, 2012), is well known mostly as a maintenance medication to prevent withdrawal symptoms and to improve quality of life for heroin-dependent patients (Blanken et al, 2012;Wang et al, 2012). One of the adverse reactions following methadone treatment is the prolongation of the cardiac QT interval determined by electrocardiogram (ECG) (Fonseca et al, 2009).…”

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confidence: 99%

Functional Genetic Polymorphisms inCYP2C19Gene in Relation to Cardiac Side Effects and Treatment Dose in a Methadone Maintenance Cohort

Wang

Tsou

et al. 2013

OMICS: A Journal of Integrative Biology

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Methadone maintenance therapy is an established treatment for heroin dependence. This study tested the influence of functional genetic polymorphisms in CYP2C19 gene encoding a CYP450 enzyme that contributes to methadone metabolism on treatment dose, plasma concentration, and side effects of methadone. Two single nucleotide polymorphisms (SNPs), rs4986893 (exon 4) and rs4244285 (exon 5), were selected and genotyped in 366 patients receiving methadone maintenance therapy in Taiwan. The steady-state plasma concentrations of both methadone and its EDDP metabolite enantiomers were measured. SNP rs4244285 allele was significantly associated with the corrected QT interval (QTc) change in the electrocardiogram ( p = 0.021), and the Treatment Emergent Symptom Scale (TESS) total score ( p = 0.021) in patients who continued using heroin, as demonstrated with a positive urine opiate test. Using the gene dose (GD) models where the CYP2C19 SNPs were clustered into poor (0 GD) versus intermediate (1 GD) and extensive (2 GD) metabolizers, we found that the extensive metabolizers required a higher dose of methadone ( p = 0.035), and showed a lower plasma R-methadone/ methadone dose ratio ( p = 0.007) in urine opiate test negative patients, as well as a greater QTc change ( p = 0.008) and higher total scores of TESS ( p = 0.018) in urine opiate test positive patients, than poor metabolizers. These results in a large study sample from Taiwan suggest that the gene dose of CYP2C19 may potentially serve as an indicator for the plasma R-methadone/methadone dose ratio and cardiac side effect in patients receiving methadone maintenance therapy. Further studies of pharmacogenetic variation in methadone pharmacokinetics and pharmacodynamics are warranted in different world populations.

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“…En cuanto a la comisión de actividades ilegales, los estudios muestran que existe una gran reducción en las tasas de incriminación (Oliver et al, 2010) y de reincidencia (Dolan et al, 2005) de los pacientes en TMM. Respecto a la calidad de vida, los pacientes muestran peores indicadores comparados con controles sanos (Iraurgi Castillo, 2007) pero se ha demostrado que mayores dosis y más permanencia en tratamiento predice la mejoría de este marcador (Wang et al, 2012). Un estudio realizado en nuestro país muestra como una mayor satisfacción del usuario y mayor calidad de vida, están estrechamente relacionadas con el número de horas que el centro dispensa metadona, el número de pacientes por centro, la frecuencia percibida de la información que se recibe acerca de los cambios de dosis, la influencia percibida de tales cambios y la disfunción social (Trujols et al, 2011).…”

Section: Marcadores Psicosociales Del Tmmunclassified

Efectividad a largo plazo de los tratamientos de mantenimiento con metadona en personas con adicción a derivados opiáceos

García

Bobes-Bascarán

2012

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There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the effectiveness of methadone as a long-term treatment for the addiction to opiates. Strengths include less illegal drug use, decreased criminal activity and better general functioning. Also physical and mental health seems to be more preserved and recovered. Since patients undergoing methadone treatment exhibit diminished likelihood of suffering from cardiovascular conditions, HIV, HCV, HBV and other infections, and lesser psychiatric comorbidity. This Editorial intends to define and guide the therapeutic statement to address the management of persons with opiate abuse or dependence. These proposals have been grounded in the main long-term studies, systematic analysis and meta-analytic approaches on the effectiveness of methadone. Thereby it is recommended, with the maximum level of evidence, methadone maintenance treatments in spite of its weaknesses (ie. Toxicity, cardiovascular risk, sedation problems and cognitive impairment), considering the clinical history, general health status, and willingness and preferences of the patient.Key words: methadone long-term treatment, methadone maintenance treatment, opiate addiction, effectiveness of methadone, doses and toxicity of methadone.Los estudios prospectivos de grandes series con distintas dosis de mantenimiento y marcadores distales estandarizados no existen, sin embargo actualmente existe evidencia acerca de la efectividad de la metadona como tratamiento a largo plazo de la adicción a opiáceos. Entre sus resultados se puede destacar un menor consumo de sustancias ilegales, menor implicación en actividades criminales y mejor funcionamiento social general. Por otra parte, la salud física y mental permanece más conservada y recuperada. Puesto que los pacientes en tratamiento con metadona presentan menos probabilidad de padecer problemas cardiovasculares, VIH, hepatitis C, hepatitis B y otros procesos infecciosos, así como una menor comorbilidad psiquiátrica. Este editorial pretende definir y guiar el posicionamiento terapéutico a la hora de abordar el manejo de personas con abuso o dependencia a opiáceos. Para fundamentar las pautas guía se han tenido en cuenta y revisado los principales estudios a largo plazo, análisis sistemáticos y aproximaciones meta-analíticas de la efectividad de la metadona. Por todo ello se recomiendan, con el máximo nivel de evidencia, los tratamientos de mantenimiento con metadona a pesar de las debilidades en cuanto a toxicidad y riesgo cardiovascular, y las dificultades de sedación y disminución del funcionamiento cognoscitivo, siempre teniendo en cuenta la historia clínica, el estado de salud general, y los deseos y preferencias del paciente.Palabras clave: tratamiento a largo plazo con metadona, tratamiento de mantenimiento con metadona, adicción a opiáceos, efectividad de la metadona, dosis y toxicidad de la metadona.Efectividad a largo plazo de los tratamientos de mantenim...

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Change in Quality of Life and Its Predictors in Heroin Users Receiving Methadone Maintenance Treatment in Taiwan: An 18-Month Follow-Up Study

Abstract: Efforts are needed to amend the modifiable factors related to poor QOL for heroin users in MMT programs.

Cited by 70 publications

References 16 publications

Opioid pharmacotherapy: Treatment, regimes, constructions and control

Opioid pharmacotherapy: Treatment, regimes, constructions and control

Functional Genetic Polymorphisms inCYP2C19Gene in Relation to Cardiac Side Effects and Treatment Dose in a Methadone Maintenance Cohort

Efectividad a largo plazo de los tratamientos de mantenimiento con metadona en personas con adicción a derivados opiáceos

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