Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain

Macey, Tara A.; Weimer, Melissa; Grimaldi, Elizabeth M; Dobscha, Steven K.; Morasco, Benjamin J.

doi:10.5055/jom.2013.0175

Cited by 11 publications

(1 citation statement)

References 29 publications

(33 reference statements)

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“…In addition, all participants were asked six questions on some of the most common subjective adverse effects attributed to MMT, including euphoria, perspiring, nausea, concentration difficulties, feeling “brain fog,” and reduced sexual desire; these symptoms were rated in the same way as for the withdrawal symptoms. The selection of the adverse effects was based on the authors clinical experiences, previously published peer-collected data on this population [ 10 ], and the most common reported side effects for methadone [ 26 , 27 ] and opioids in general [ 28 ]. Perspiring and nausea were defined as adverse effects or withdrawal symptoms based on how each participant perceived them.…”

Section: Methodsmentioning

confidence: 99%

Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway

Chalabianloo

Høiseth

Ohldieck

et al. 2021

Subst Abuse Treat Prev Policy

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Background There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments. Methods This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms using 16 items Subjective Opioid Withdrawal Scale (SOWS) questionnaire, self-reported adverse effects, and substance use was obtained. Linear mixed modelling was used for analyzing the data. Results The mean age of the participants was 45 years, and 33% were women. Almost half reported mild to moderate subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. The use of at least one substance was reported by 88% of the participants. Serum concentration-to-dose ratios were lower among those who had reported subjective opioid withdrawal symptoms (p) = 0.039). The total SOWS score (p < 0.001); the specific subjective withdrawal symptoms of anxiety (p = 0.004), bone and muscle aches (p = 0.003), restlessness (p = 0.017), and (slightly) shaking (p = 0.046), also use of heroin (p = 0.015) and alcohol (p = 0.011) were associated with lower methadone concentrations. Cannabis use was slightly related to higher methadone concentrations (p = 0.049). Conclusions The findings suggest that the patient’s self-perceived symptoms and current clinical condition are related to the serum concentrations of methadone. This interpretation supports dose adjustments based on patient-reported symptoms. In some aberrant cases, measurement of serum concentrations together with other individual assessments may be considered to support the clinical decision.

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Section: Methodsmentioning

confidence: 99%

Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway

Chalabianloo

Høiseth

Ohldieck

et al. 2021

Subst Abuse Treat Prev Policy

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Oral and dental health of Italian drug addicted in methadone treatment

Giudice

Cicciù

Polimeni

et al. 2019

Oral Science International

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Objectives Our group recorded the characteristic of oro‐dental health among a group of drug addicts in recovery treatment with methadone, and it evaluated the changes related to the withdrawal therapy. Methodology A sample of 50 drug addicts in treatment with methadone was included in this study. At the beginning of the withdrawal therapy, the authors recorded the parameters involved in the most common oral diseases. Moreover, it was evaluated how, during the rehabilitation protocol, the behavioral parameters and the xerostomia that influence the oral health changed. A medical history especially referring to drug addiction features was made. An intraoral objective exam was done for each patient, at the beginning of the therapy and after 3 and 6 months. Results 82% of the subjects showed a DMFT > 0. No patient showed any presences of previous restorative therapies. Lowenthal's caries, mostly localized in the cervical upper maxillary incisor, were found in 12% of the subjects. The Löe and Silness index showed marginal gingivitis in 95% of subjects, whereas 44% showed improper occlusion and/or parafunctional habits. 52% of the subjects had a normal diet, but a qualitative evaluation showed a high percentage (48%) of immoderate refined sugars use. Xerostomia, that was present in 72% of patients during the drug dependence period, showed a marked reduction in the withdrawal period. Conclusion The group analyzed made a combined use with other drugs. They showed a high rate of caries and marginal periodontitis. The statistical analysis of the data proves how the methadone rehabilitation program is effective even on the oral health. It will show its effects over two different time related phases: after a first phase of decreased attention to oral health (0‐3 months), all index will increase in the long term (3‐6 months). The rehabilitation program contributes to an improved oral health of drug addicts.

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Opioid Use and the Risk of Ventricular Arrhythmias: A Systematic Review and Meta‐Analysis

Salmasi,

Igweokpala,

Douros

et al. 2024

Pharmacoepidemiology and Drug

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BackgroundThe association between opioid use and the risk of ventricular arrhythmias (VA) is poorly understood.AimsThe objective of this study was to synthesize the evidence on the risk of VA associated with opioid use.Materials & MethodsWe systematically searched the Cochrane Library, Embase, MEDLINE, and CINAHL databases in July 2022. Risk of bias was assessed using the Cochrane risk for bias tool for randomized controlled trials (RCTs) and ROBINS‐I for observational studies. Certainty of evidence was assessed using GRADE.ResultsWe included 15 studies (12 observational, 2 post hoc analyses of RCTs, 1 RCT). Most studies focused on opioid use for maintenance therapy (n = 9), comparing methadone to buprenorphine (n = 13), and reported QTc prolongation (n = 13). Six observational studies had a critical risk of bias, and one RCT was at high risk of bias. Two studies could not be included in the meta‐analysis as they reported a different outcome and studied an opioid antagonist. Meta‐analysis of 13 studies indicated that the use of methadone was associated with an increased risk of VA compared to the use of buprenorphine, morphine, placebo, or levacetylmethadol (risk ratio [RR], 2.39; 95% CI, 1.31–4.35; I2 = 60%). The pooled estimate varied greatly between observational studies (RR, 2.12; 95% CI, 1.15–3.91; I2 = 62%) and RCTs (RR, 14.09; 95% CI, 1.52–130.61; I2 = 0%), but both indicated an increased risk.ConclusionIn this systematic review and meta‐analysis, we found that methadone use is associated with more than twice the risk of VA compared to comparators. However, our findings should be interpreted cautiously given the limited quality of the available evidence.

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Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain

Cited by 11 publications

References 29 publications

Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway

Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway

Oral and dental health of Italian drug addicted in methadone treatment

Opioid Use and the Risk of Ventricular Arrhythmias: A Systematic Review and Meta‐Analysis

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