Comparison of the Effect of High and Low Doses of Methadone on Treatment Outcome

Siassi, Iradj; Angle, Burleigh P.; Alston, Dominick C.

doi:10.3109/10826087709027267

Cited by 16 publications

(2 citation statements)

References 15 publications

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“…The outcome and the retention rate in therapy of our treatment-resistant NDD or DD patients did not differ from that of long-term standard MMT programs [30][31][32] . The main difference between our program and the Italian standard MMT lies in the amount of methadone administered during the stabilization phase; this ranged from 80 to 400 mg/day in our protocols and from 40 to 100 mg/day in standard protocols.…”

Section: Discussionmentioning

confidence: 88%

Long-Term Outcomes of Treatment-Resistant Heroin Addicts with and without DSM-IV Axis 1 Psychiatric Comorbidity (Dual Diagnosis)

Maremmani

Pacini²,

Lubrano³

et al. 2008

Eur Addict Res

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Objective: The aim of this study was to compare the long-term outcomes of treatment-resistant heroin addicts with and without DSM-IV axis I psychiatric comorbidity (dual diagnosis). Method: 129 heroin addicts who also met criteria for treatment resistance, 66 with one or more DSM-IV axis I psychiatric diagnosis (DD patients), and 63 without DSM-IV axis I psychiatric comorbidity (NDD patients) were monitored prospectively (6 years on average, min. 1, max. 9) along a methadone maintenance treatment program (MMTP). Results: The rates for survival-in-treatment were about 50% for NDD patients and about 70% for DD patients. After 4 years of treatment onwards, such rates tended to become stable. DD patients showed better outcome measures than NDD patients. A significantly higher methadone dose was needed to have DD patients stabilized. Conclusions: Contrary to expectations, treatment-resistant patients with psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.

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Section: Discussionmentioning

confidence: 88%

Long-Term Outcomes of Treatment-Resistant Heroin Addicts with and without DSM-IV Axis 1 Psychiatric Comorbidity (Dual Diagnosis)

Maremmani

Pacini²,

Lubrano³

et al. 2008

Eur Addict Res

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“…This issue has precedents in the context of methadone treatment, as there have been historical divisions amongst clinicians and policymakers regarding whether “higher-dose” or “lower-dose” methadone is preferable. The clinical trials literature offers consistent support for the policy that, when safe for the individual patient, higher maintenance doses that provide blockade in addition to withdrawal suppression generally produce better outcomes than lower doses (Siassi et al, 1977; Ling et al, 1996, 1998; Strain et al, 1993, 1999). …”

Section: Methodsmentioning

confidence: 92%

Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: Implications for clinical use and policy

Greenwald

Comer

Fiellin

2014

Drug and Alcohol Dependence

137

118

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Background Sublingual formulations of buprenorphine (BUP) and BUP/naloxone have well-established pharmacokinetic and pharmacodynamic profiles, and are safe and effective for treating opioid use disorder. Since approvals of these formulations, their clinical use has increased. Yet, questions have arisen as to how BUP binding to mu-opioid receptors (μORs), the neurobiological target for this medication, relate to its clinical application. BUP produces dose- and time-related alterations of μOR availability but some clinicians express concern about whether doses higher than those needed to prevent opioid withdrawal symptoms are warranted, and policymakers consider limiting reimbursement for certain BUP dosing regimens. Methods We review scientific data concerning BUP-induced changes in μOR availability and their relationship to clinical efficacy. Results Withdrawal suppression appears to require ≤50% μOR availability, associated with BUP trough plasma concentrations ≥1 ng/mL; for most patients, this may require single daily BUP doses of 4-mg to defend against trough levels, or lower divided doses. Blockade of the reinforcing and subjective effects of typical doses of abused opioids require <20% μOR availability, associated with BUP trough plasma concentrations ≥3 ng/mL; for most individuals, this may require single daily BUP doses >16-mg, or lower divided doses. For individuals attempting to surmount this blockade with higher-than-usual doses of abused opioids, even larger BUP doses and <10% μOR availability would be required. Conclusion For these reasons, and given the complexities of studies on this issue and comorbid problems, we conclude that fixed, arbitrary limits on BUP doses in clinical care or limits on reimbursement for this care are unwarranted.

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Methadone maintenance at different dosages for opioid dependence

Faggiano

Vigna‐Taglianti

Versino³

et al. 2003

Cochrane Database of Systematic Reviews

301

219

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Comparison of the Effect of High and Low Doses of Methadone on Treatment Outcome

Cited by 16 publications

References 15 publications

Long-Term Outcomes of Treatment-Resistant Heroin Addicts with and without DSM-IV Axis 1 Psychiatric Comorbidity (Dual Diagnosis)

Long-Term Outcomes of Treatment-Resistant Heroin Addicts with and without DSM-IV Axis 1 Psychiatric Comorbidity (Dual Diagnosis)

Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: Implications for clinical use and policy

Methadone maintenance at different dosages for opioid dependence

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