Exploring the relationship between perceived inter-dose opioid withdrawal and patient characteristics in methadone maintenance treatment

Elkader, Alex K.; Brands, Bruna; Callaghan, Russell C.; Sproule, Beth

doi:10.1016/j.drugalcdep.2009.07.003

Cited by 22 publications

(12 citation statements)

References 36 publications

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“…During the MMT induction process, withdrawal can occur intermittently due to the required interplay of opioid abstinence symptoms at admission, the slow federally regulated dose titration, and inter-individual differences in methadone metabolism (Coller, Barratt, Dahlen, Loennechen, & Somogyi, 2006; Eap, Buclin, & Baumann, 2002). Throughout this transitional period, the likelihood of withdrawal symptoms escalates as the time elapsed since the previous dose of methadone increases, which exacerbates stress-related cravings (Dyer & White, 1997; Ilgen, Jain, Kim, & Trafton, 2008) and renders individuals vulnerable to psychological distress and negative moods (Elkader, Brands, Callaghan, & Sproule, 2009). Requisite time commitments from the recovery program and lifestyle changes, in the midst of continued environmental and personal drug-related cues (Epstein et al, 2014), contribute to transitional difficulties.…”

Section: Introductionmentioning

confidence: 99%

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Jaremko

Sterling

Bockstaele

2015

Journal of Substance Abuse Treatment

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The present study investigated whether psychological and/or physiological measures of stress would impede induction onto methadone maintenance and predict early (<6 months) discontinuation. Compared with controls, opioid-dependent subjects displayed increased distress on the perceived stress scale (PSS) and post-traumatic stress disorder checklist (PCLC); 60% exhibited abnormal cortisol. Addiction severity index (ASI), drug-use, and stress indices explained between 17–37% of the variance in engagement including attendance, opioid abstinence, and methadone stabilization. Participants who discontinued treatment displayed poor engagement, abnormal cortisol, elevated withdrawal symptoms, higher distress, and increased ongoing opioid use versus compliant individuals. Discontinuation was initially related to drug-use severity; however, by 6 months, retention depended primarily upon cortisol abnormalities, which increased an individual’s discontinuation risk by 7.7-fold. These findings support admission screening with the ASI/cortisol for drop out, and stress/drug-use indices for engagement that together may enable clinically-relevant early recognition and interventions for prevention of stress-induced relapse in opioid-dependent populations.

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Section: Introductionmentioning

confidence: 99%

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Jaremko

Sterling

Bockstaele

2015

Journal of Substance Abuse Treatment

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“…Dose titration proceeds through initiation, induction, and stabilization phases prior to reaching a maintenance phase . The initial period of methadone dose stabilization is one of particular vulnerability to relapse due to the persistence of low‐moderate grade opiate withdrawal and associated stress during dose titration . Non‐opiate illicit drug use often persists during the early phases of treatment for opiate dependence, promoted at least in part by the experience of withdrawal and craving.…”

Section: Introductionmentioning

confidence: 99%

Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment

et al. 2013

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Background and Objectives Illicit drug use, particularly of cannabis, is common among opiate-dependent individuals, and has the potential to impact treatment in a negative manner. Methods To examine this, patterns of cannabis use prior to and during methadone maintenance treatment (MMT) were examined to assess possible cannabis-related effects on MMT, particularly during methadone stabilization. Retrospective chart analysis was used to examine outpatient records of patients undergoing MMT (n=91), focusing specifically on past and present cannabis use and its association with opiate abstinence, methadone dose stabilization, and treatment compliance. Results Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization. History of cannabis use correlated with cannabis use during MMT, but did not negatively impact the methadone induction process. Pilot data also suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization. Conclusions and Scientific Significance The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions.

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“…In addition, we evaluated pain-related negative affect using ratings of anxiety and a measure of pain catastrophizing 13,28 . As high levels of general negative affect are associated with elevated opioid craving and opioid withdrawal symptoms 38 , and as catastrophizing specifically correlates with individual differences in opioid analgesia 40 , we hypothesized that catastrophizing would be associated with a greater degree of hyperalgesia, particularly in the group of patients using opioid medications.…”

Section: Introductionmentioning

confidence: 99%

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

Edwards

Wasan

Michna

et al. 2011

The Journal of Pain

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This study employed quantitative sensory testing (QST) to evaluate pain responses in chronic spinal pain patients at low risk and high risk for opioid misuse, with risk classification based on scores on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Patients were further sub-grouped according to current use of prescription opioids. Of the 276 chronic pain patients tested, approximately 65% were taking opioids; a median split was used to further categorize these patients as being on lower or higher doses of opioids. The highrisk group (n= 161) reported higher levels of clinical pain, had lower pressure and thermal pain thresholds at multiple body sites, had lower heat pain tolerance, and rated repetitive mechanical stimuli as more painful relative to the low-risk group (n= 115; p’s< .01). In contrast, QST measures did not differ across opioid groups. Multiple linear regression analysis suggested that indices of pain-related distress (i.e., anxiety and catastrophizing about pain) were also predictive of hyperalgesia, particularly in patients taking opioids. Collectively, regardless of opioid status, the high-risk group was hyperalgesic relative to the low-risk group; future opioid treatment studies may benefit from the classification of opioid risk, and the examination of pain sensitivity and other factors that differentiate high- and low-risk groups.

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Exploring the relationship between perceived inter-dose opioid withdrawal and patient characteristics in methadone maintenance treatment

Cited by 22 publications

References 36 publications

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

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