Methadone at tapered doses for the management of opioid withdrawal

Amato, Laura; Davoli, Marina; Minozzi, Silvia; Ali, Robert; Ferri, Marica

doi:10.1002/14651858.cd003409.pub3

Cited by 49 publications

(15 citation statements)

References 82 publications

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“…These poor outcomes are consistent with the findings of prior analyses 9–15 , and are observed despite the frequency with which tapers are observed in BC, contrary to clinical guideline recommendations. Further, longer duration of exposure in treatment is associated with improved post-treatment outcomes such as reduced opioid use, reduced criminal activity, improved social productivity and reduced risk of mortality 29, 35−38 .…”

Section: Discussionsupporting

confidence: 87%

“…Systematic reviews of methadone detoxification indicated that while withdrawal severity can be reduced, the majority of patients relapse to heroin use 9 , though success is more likely with additional psychosocial care 10 . In fact, very few patients complete the process of tapering from MMT 11–15 , and relapse is common among those who do reach a state of abstinence 16 .…”

Section: Introductionmentioning

confidence: 99%

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

Nosyk

Sun

Evans³

et al. 2012

Addiction

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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

Nosyk

Sun

Evans³

et al. 2012

Addiction

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“…28,29 A 2005 Cochrane review found that although some other pharmacologic agents had comparable rates of detoxification with methadone, all were associated with equally high rates of relapse. 30 Addiction is basically a memory that has not gone away when the drug is stopped, and long-term relapse prevention is usually required.…”

Section: At the Crossroads: Questions For Dr O’brienmentioning

confidence: 99%

A 50-Year-Old Woman Addicted to Heroin

O’Brien

2008

JAMA

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Heroin addiction is a complicated medical and psychiatric issue, with well-established as well as newer modes of treatment. The case of Ms W, a 50-year-old woman with a long history of opiate addiction who has been treated successfully with methadone for 9 years and who now would like to consider newer alternatives, illustrates the complex issues of heroin addiction. The treatment of heroin addiction as a chronic disease is reviewed, including social, medical, and cultural issues and pharmacologic treatment with methadone and the more experimental medication options of buprenorphine and naltrexone.Dr Ship: Ms W is a 50-year-old woman being treated with methadone maintenance. She lives in Boston and has Medicare.Ms W began using heroin at age 14 years. She used intravenous heroin but has subsequently sniffed it as well. Friends of hers used the drug and she decided to try it. Initially she did not like it, but she returned to it for reasons she cannot understand and became addicted. She supported her habit with stealing, armed robbery, and prostitution. She has been in detoxification "more than 20 times" and had repeated difficulties remaining free from heroin use. She finds that at times of stress it is very difficult to refrain from using heroin, and she relapses.Ms W currently receives maintenance methadone, 108 mg/d. She gets her methadone once a week and sees a counselor as well. She has tried to reduce her methadone dose several times unsuccessfully. Each time, she found herself returning to heroin use. She is tired of taking methadone and would like to try buprenorphine. She hopes that this would prevent her from getting the desperate feeling she has occasionally for heroin and allow her eventually to be drug free.Ms W has 2 living children and 5 grandchildren. She lost 1 teenaged daughter to a gunshot wound. Ms W completed 10th grade and acquired her GED (General Education

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“…Research indicates that detoxification has limited long-term effectiveness (Amato, Davoli, Minozzi, Ali, & Ferri, 2005; Amato et al, 2008; Ling et al, 2009; Wesson & Smith, 2010), however, there may be some individuals for whom a short-term period of pharmacotherapy is sufficient for initiating and maintaining positive treatment outcome. In some cases, it may be the preferred treatment when compared with long-term maintenance treatment (Poirier et al, 2004; Stein, Cioe, & Friedmann, 2005; Sigmon, Dunn, Badger, Heil, & Higgins, 2009).…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcome after short-term stabilization with buprenorphine

Hillhouse

Canamar

Ling

2013

Journal of Substance Abuse Treatment

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Using buprenorphine as a medication to treat opioid dependence is becoming more prevalent as illicit opiate use increases. Identifying the characteristics of opiate dependent individuals best suited to benefit from buprenorphine would improve guidelines for its administration. This study evaluates baseline and treatment participation variables for predicting positive response to short-term stabilization with buprenorphine. Data includes demographic, drug use, and other variables collected from participants undergoing stabilization over a 4-week period before being tapered off buprenorphine in a short-term detoxification process. Outcome variables include opioid use and retention. Logistic regression results indicate several characteristics associated with opioid use at the end of the stabilization period. These include being older, having no criminal history, and less opiate use. Criminal activity and opioid use in the last 30 days were significantly associated with shorter treatment stays. The benefits of identifying individual characteristics that may predict treatment response are discussed.

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Methadone at tapered doses for the management of opioid withdrawal

Cited by 49 publications

References 82 publications

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

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

A 50-Year-Old Woman Addicted to Heroin

Predictors of outcome after short-term stabilization with buprenorphine

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