Cognitive Functioning During Methadone and Buprenorphine Treatment

Abstract

Cognitive impairment in drug-dependent patients receiving methadone (MMP) maintenance treatment has been reported previously. We assessed cognitive functioning after at least 14 days of stable substitution treatment with buprenorphine (BUP) or MMP and after 8 to 10 weeks. We performed a randomized, nonblinded clinical trial in 59 drug-dependent patients receiving either BUP or MMP maintenance treatment and healthy normal controls (n = 24) matched for sex, age, and educational level. Thirteen patients dropped out of the study before the second testing was performed (BUP, n = 22; MMP, n = 24). A neuropsychological test battery was used to measure selective attention, verbal memory, motor/cognitive speed, and cognitive flexibility. In addition, subjective perceived stress was assessed with a questionnaire. Patients in both treatment groups performed equally well in all of the cognitive domains tested. Both BUP and MMP patients showed significantly improved concentration and executive functions after 8 to 10 weeks of stable substitution treatment. The control group achieved better results than the BUP and MMP groups in most cognitive domains, indicating cognitive impairment in the patients. Perceived stress did not show any significant change after 8 to 10 weeks of treatment, and no major differences were detected between the 3 groups. No effects of perceived stress on cognitive function were found. Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP or MMP compared with healthy controls. Selective attention improved in both patient groups during treatment. We propose that the improvement of attention may facilitate rehabilitation of drug-dependent patients.

Neuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapy

“…Some studies have described partial recovery of cognitive deficits during abstinence. Opioid addicts exhibit less severe PFC cognitive deficits during abstinence than during drug consumption (Gruber et al, 2007;Soyka et al, 2008). In one study, addicts under stable treatment with either buprenorphine or methadone for 8-10 weeks both exhibited improvement in concentration skills and executive functions but their performance was still inferior to that of controls, indicating residual cognitive impairment in both groups (Soyka et al, 2008).…”

“…Opioid addicts exhibit less severe PFC cognitive deficits during abstinence than during drug consumption (Gruber et al, 2007;Soyka et al, 2008). In one study, addicts under stable treatment with either buprenorphine or methadone for 8-10 weeks both exhibited improvement in concentration skills and executive functions but their performance was still inferior to that of controls, indicating residual cognitive impairment in both groups (Soyka et al, 2008). Consistently, our results suggest that this functional recovery may be incomplete since we observed persistent deficient performances in former heroin users mainly on tests associated with frontal lobe functioning.…”

The effects of acute and chronic steady state methadone on memory retrieval in rats

“…Despite its clinical usefulness, some studies have reported negative effects on learning and memory, but these impairments are difficult to dissociate from the effects of previous/concurrent drug abuse, physical correlates of substance dependence (e.g., withdrawal, pain, trauma, blood-born infectious diseases), and disadvantaged social context (Darke et al 2000;Davis et al 2002;Gritz et al 1975;Isbell and Vogel 1949;Soyka et al 2008;Verdejo et al 2005;Hilsabeck et al 2002;Mintzer and Stitzer 2002;Ornstein et al 2000;Prosser et al 2006;Veldhuijzen et al 2006).…”

Neuropsychological Status of Heroin Users Undergoing Methadone Maintenance in Harm Reduction Program and Therapeutic Community

“…Impairments in attention and memory functions (Ersche et al 2006;Fishbein et al 2007;Soyka et al 2008), and in higher cognitive domains of executive functioning (Brand et al 2008) and decision making (Bechara 2005;Pirastu et al 2006) have been extensively reported for heroin users. In addition, some studies have also suggested that methadone use is related to a decrease in cognitive functioning, particularly in memory (Darke et al 2012), mental flexibility (Verdejo et al 2005) and psychomotor performance (Mintzer et al 2005), although there are reports suggesting that recovery might be possible once a patient is stabilized in methadone (Davis et al 2002).…”