Defining dosing pattern characteristics of successful tapers following methadone maintenance treatment: results from a population‐based retrospective cohort study

Abstract

Aims Identify dose tapering strategies associated with sustained success following methadone maintenance treatment (MMT). Design Population-based retrospective cohort study. Setting Linked administrative medication dispensation data from British Columbia, Canada. Participants From 25,545 completed MMT episodes, 14,602 of which initiated a taper, 4,183 individuals (accounting for 4,917 MMT episodes) from 1996–2006 met study inclusion criteria. Measurements The primary outcome was sustained successful taper, defined as a daily dose ≤5mg per day in the final week of the treatment episode and no treatment re-entry, opioid-related hospitalization, or mortality within 18 months following episode completion. Findings The overall rate of sustained success was 13% among episodes meeting inclusion criteria (646/4,917), 4.4% (646/14,602) among all episodes initiating a taper, and 2.5% (646/25,545) among all completed episodes in the dataset. The results of our multivariate logistic regression analyses suggested that longer tapers had substantially higher odds of success (12–52 weeks vs. <12 weeks: Odds ratio: 3.58; 95% confidence interval: 2.76 – 4.65); > 52 weeks vs. < 12 weeks: 6.68 (5.13 – 8.70)), regardless of how early in the treatment episode the taper was initiated, and a more gradual, stepped tapering schedule, with dose decreases scheduled in only 25–50% of the weeks of the taper, provided the highest odds of sustained success (vs. <25%: 1.61 (1.22–2.14)). Conclusions The majority of patients attempting to taper from methadone maintenance treatment will not succeed. Success is enhanced by gradual dose reductions interspersed with periods of stabilization. These results can inform the development of a more refined guideline for future clinical practice.

Patterns of Abstinence or Continued Drug Use Among Methadone Maintenance Patients and Their Relation to Treatment Retention

“…In spite of the scientific evidence supporting MMT as a treatment for opioid addiction, several interconnected issues undermine the success of MMT as a medical treatment and as an instrument of national drug policy. These include the public and professional stigma attached to MMT (Vigilant 2008;2004;Joseph 1995;Murphy & Irwin 1992), attitudes toward MMT by opioid users and their effects on MMT attraction and enrollment (Trenz et al 2012;Fiellin & O'Connor 2002), the presence, severity, and complexity of co-occurring medical and psychiatric conditions of MMT patients (Pani et al 2011;Carpentier et al 2009), continued drug and alcohol use during MMT (Davstad et al 2007;Stenbacka et al 2007;Peles, Schreiber & Adelson 2006), patient retention within MMT (Zhang, Friedmann & Gerstein 2003;Stancliff et al 2002), and post-MMT recurrence of opioid addiction (Nosyk et al 2012;Amato et al 2011;Noble et al 2002;Magura & Rosenblum 2001). The present paper focuses on two of these challenges: continued drug use during MMT and MMT attrition.…”

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

“…Por tanto, la dosis media estimada de metadona deberá comprender un rango de entre 60-100 mg diarios, recomendando un inicio gradual con dosis menores para evitar los riesgos asociados a la introducción de metadona (Lingford-Hughes, Welch, Peters y Nutt, 2012). En cuanto a la reducción del TMM, se ha comprobado que aquellos pacientes con reducciones de dosis más graduales, mostraban mayor porcentaje de éxito a largo plazo (Nosyk et al, 2012).…”

“…Este tipo de abordaje es especialmente relevante si se tiene en cuenta que los pacientes que abandonan el tratamiento suelen tener más recaídas, mayor tasa de mortalidad que aquellos que permanecen (Kleber, 2008). A este respecto, se debe tener presente que a pesar de que las revisiones sistemáticas acerca de la desintoxicación farmacológica muestran que la gravedad de la abstinencia se puede reducir, la mayor parte de los pacientes recaen, por lo que las mayores tasas de éxito se conseguirán si se aplica una intervención de cuidados psicosociales coadyuvantes (Nosyk et al, 2012).…”

Development of OSTQOL: A Measure of Quality of Life for Patients in Opioid Substitution Treatment

“…Treatment goals typically include sustained abstinence from opioids and reduced drug use [3]. However, only up to 7% of patients achieve abstinence [4, 5] and reduced drug use is not necessarily correlated with enhanced personal well-being [6]. As the vast majority of patients remain in OST indefinitely, it can be argued that the improvement of patients’ subjective well-being and quality of life (QOL) during OST should be a primary goal in patient care.…”