Pharmacotherapy in the Treatment of Addiction: Methadone

Abstract

Methadone maintenance treatment is the most widely available pharmacotherapy for opioid addiction and has been shown over a period of 40 years to be an effective and safe treatment. While women comprise approximately 40% of clients currently being treated in MMT programs, comparatively little research geared specifically toward this group has been published. This article begins with an overview of neurobiological studies on opioid addiction, including a discussion of gender differences, followed by a review of the pharmacology of methadone The authors then examine the particular needs and differences of women being treated in MMTs, including co-dependence with other substances, women’s health issues and psychosocial needs unique to this population. In conclusion, research shows that women have different substance abuse treatment needs in comparison to their male counterparts. One New York City MMT program that has attempted to address these differences is highlighted.

A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

“…Over four decades of research indicates that agonist maintenance therapy (AMT) utilizing methadone (a full opioid agonist) and, more recently, buprenorphine (a partial opioid agonist) is the most effective treatment for opioid dependence (Kleber, 2008; Kreek et al, 2010; Mattick et al, 2008). Social, economic and regulatory barriers limit access to AMT and consequently detoxification followed by psychosocial counseling, with accompanying high relapse rates, is the most common approach to opioid dependence treatment (Mattick et al, 2009; Mayet et al, 2005).…”

Sex differences in opioid use and medical issues during buprenorphine/naloxone treatment

“…Women also have poorer treatment participation and retention than men in mixed-gender treatment settings (23). A consensus exists that women have different needs and deficient gender-specific services lead to barriers to care (24). Treatment that focuses on problems more common to substance-abusing women is effective (25).…”

Transporter-Mediated Disposition of Opioids: Implications for Clinical Drug Interactions

“…In recent years, its demonstrated clinical efficacy and cost-effectiveness have made methadone an increasingly prescribed opioid, particularly in treating moderate-to-severe pain (211,212). Methadone consists of a racemic mix of R-and S-methadone (213), though the Risomer is believed to account for its opioid effects (214). Methadone is also lipophilic, highly protein bound (85%), and known for its relatively long half-life (215) and often unpredictable pharmacokinetics (216).…”