Three Oral Formulations of Methadone A Clinical and Pharmacodynamic Comparison

Gourevitch, Marc N.; Hartel, Diana; Tenore, Peter L.; Freeman, Katherine; Marion, Ira J.; Hecht, Joe; Lowinson, Joyce H.

doi:10.1016/s0740-5472(99)00008-2

Cited by 13 publications

(8 citation statements)

References 7 publications

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“…These findings are in line with previous research documenting high rates of what has been defined as “change intolerance” to the introduction of new methadone formulations (Silver & Shaffer, 1996; Steels, Hamilton, & McLean, 1992). Although limited clinical evidence support a psychological (e.g., perceived lower efficacy due to lower volumes) rather than a biological or pharmacological basis underlying withdrawal symptoms (Gourevitch, et al, 1999), it may also be partially explained by dispensation challenges with the new formulation, including difficulties in titrating doses (McNeil, et al, 2015). Regardless, its adverse social and health effects cannot be overlooked.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, accidental opioid-related overdose deaths have become one of the leading causes of injury deaths in North America, exceeding deaths from motor-vehicle accidents in many American states and Canadian provinces (Compton, et al, 2016; Gourevitch, et al, 1999; King, et al, 2014). In addition to overdose deaths and other medical complications related to chronic opioid use, opioid use disorder (OUD) has been linked to increased risk of transmitting and acquiring blood-borne viruses, including HIV and viral hepatitis, through the sharing of injection equipment (Degenhardt & Hall, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Unintended impacts of regulatory changes to British Columbia Methadone Maintenance Program on addiction and HIV-related outcomes: An interrupted time series analysis

Socías

Wood

McNeil

et al. 2017

International Journal of Drug Policy

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Background In February 2014, several regulatory reforms were introduced to the methadone maintenance treatment (MMT) program in British Columbia, Canada, including a switch to a ten-times more concentrated methadone formulation and restrictions in pharmacy delivery services. We evaluated possible unintended effects of these changes on illicit drug use patterns and HIV treatment outcomes among HIV-positive opioid users. Methods Data was drawn from ACCESS, a prospective community-recruited cohort of HIV-positive people who use illicit drugs in Vancouver, Canada. Interrupted time series analyses were used to evaluate impacts of the policy change on monthly rates of MMT enrollment, illicit heroin injection, antiretroviral therapy (ART) adherence, and HIV viral suppression among HIV-positive opioid users between November 2012 and May 2015. Results A total of 331 HIV-positive opioid users were included. The MMT policy change led to a significant immediate 11.5% increase in heroin injection, and 15.9% drop in optimal ART adherence. A gradual increase in the prevalence of MMT enrolment after the policy change was also documented (0.9% per month). No changes in viral suppression rates were observed. Conclusions We observed immediate increases in illicit heroin injection and decreases in ART adherence in the wake of regulatory changes to the local MMT program. These findings underscore the need to consider potential unintended effects of altering health programmes for vulnerable populations, the need to develop appropriate mitigation strategies, as well as to involve all relevant stakeholders in the planning and implementations of new policies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unintended impacts of regulatory changes to British Columbia Methadone Maintenance Program on addiction and HIV-related outcomes: An interrupted time series analysis

Socías

Wood

McNeil

et al. 2017

International Journal of Drug Policy

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“…However, evidence demonstrating the effectiveness of Methadose® in comparison to other formulations appears limited. While finding no differences in pharmacodynamic or clinical measures, the only study comparing methadone formulations (including Methadose®) was limited to 18 people on methadone who were drug abstinent and HIV-negative (Gourevitch et al, 1999). …”

Section: Discussionmentioning

confidence: 99%

Negotiating structural vulnerability following regulatory changes to a provincial methadone program in vancouver, canada: A qualitative study

McNeil

Kerr

Anderson

et al. 2015

Social Science & Medicine

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While regulatory frameworks governing methadone maintenance therapy (MMT) require highly regimented treatment programs that shape treatment outcomes, little research has examined the effects of regulatory changes to these programs on those receiving treatment, and located their experiences within the wider context of socialstructural inequities. In British Columbia (BC), Canada, provincial regulations governing MMT have recently been modified, including: replacing the existing methadone formulation with Methadose® (pre-mixed and 10 times more concentrated); prohibiting pharmacy delivery of methadone; and, prohibiting pharmacies incentives for methadone dispensation. We undertook this study to examine the impacts of these changes on a structurally vulnerable population enrolled in MMT in Vancouver, BC. Qualitative interviews were conducted with 34 people enrolled in MMT and recruited from two ongoing observational prospective cohort studies comprised of drug-using individuals in the six-month period in 2014 following these regulatory changes. Interview transcripts were analyzed thematically, and by drawing on the concept of ‘structural vulnerability’. Findings underscore how these regulatory changes disrupted treatment engagement, producing considerable health and social harms. The introduction of Methadose® precipitated increased withdrawal symptoms. The discontinuation of pharmacy delivery services led to interruptions in MMT and codispensed HIV medications due to constraints stemming from their structural vulnerability (e.g., poverty, homelessness). Meanwhile, the loss of pharmacy incentives limited access to material supports utilized by participants to overcome barriers to MMT, while diminishing their capacity to assert some degree of agency in negotiating dispensation arrangements with pharmacies. Collectively, these changes functioned to compromise MMT engagement and increased structural vulnerability to harm, including re-initiation of injection drug use and participation in high-risk incomegenerating strategies. Greater attention to the impacts of social-structural inequities on MMT engagement is needed when modifying MMT programs, especially as other jurisdictions are adopting similar changes. Comprehensive environmental supports should be provided to minimize adverse outcomes during transitional periods.

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“…As in the recently published, large-scale study by Anglin et al [2] , our study was randomized, but treatment was not blinded. This may be surprising for a prospective multi-centre trial, but there are several good reasons for an open-label comparison of methadone and LAAM: (1) Experienced opioid users are able to tell the diff erence between LAAM and methadone due to the faster increase of serum levels after methadone intake independent of formulation [17] . This may cause a slight feeling of euphoria or being " drugged " and is presumably less frequent under LAAM maintenance.…”

Section: Secondary Criteria Of Effi Cacymentioning

confidence: 99%

A Randomized, Open-label Trial Comparing Methadone and Levo-Alpha-Acetylmethadol (LAAM) in Maintenance Treatment of Opioid Addiction

Wolstein

Gastpar²,

Finkbeiner³

et al. 2009

Pharmacopsychiatry

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Three Oral Formulations of Methadone A Clinical and Pharmacodynamic Comparison

Cited by 13 publications

References 7 publications

Unintended impacts of regulatory changes to British Columbia Methadone Maintenance Program on addiction and HIV-related outcomes: An interrupted time series analysis

Unintended impacts of regulatory changes to British Columbia Methadone Maintenance Program on addiction and HIV-related outcomes: An interrupted time series analysis

Negotiating structural vulnerability following regulatory changes to a provincial methadone program in vancouver, canada: A qualitative study

A Randomized, Open-label Trial Comparing Methadone and Levo-Alpha-Acetylmethadol (LAAM) in Maintenance Treatment of Opioid Addiction

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