Chronic opiate use during methadone detoxification: effects of a dose increase treatment

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

Objectives: It is widely accepted that buprenorphine maintenance treatment (BMT) with dosages above 8 mg daily is effective for patients with heroin use disorder. In this study, the authors evaluated the effectiveness of long-term BMT for heroin users in China, with dosages kept on a much smaller level. Methods: This is a retrospective observational study of 72 patients who had undergone detoxification and continued with buprenorphine maintenance between 2007 and 2016. Measurements such as self-reported relapse status, buprenorphine doses, protracted symptoms, general health condition, and self-reported side effects were included. Results: At the time of interview, 51 patients had remained abstinent at follow-up (including 13 who were opioid-free). The dosages of buprenorphine were 1.33 ± 0.88 (ranging 0.3-3.5) mg/day when maintenance treatment was initiated and 1.2 ± 0.8 (ranging 0.2-3.2) mg/day at the last follow-up. The remaining patients had either relapsed on heroin (n = 11) or switched to compulsory treatment (n=10). In general, abstinent patients had minimal protracted symptoms, especially in physical symptoms. Opioid-free abstainers were more likely to report good physical health than patients on buprenorphine. Predictors of worse outcomes (relapsed or switched to compulsory treatment) were lower education levels, younger age, and younger onset of illicit drug use. Conclusions: This study shows promising results of minimal-dosage BMT in treating heroin use disorder. We recommend further studies applying minimal-dosage BMT in China and worldwide.

Impact of HIV risk and infection on delivery of psychosocial treatment services in outpatient programs

HIV risk and HIV infection have profoundly affected the delivery of psychosocial treatment services in outpatient drug treatment settings. First, HIV has changed the programmatic emphasis of outpatient treatment, from the intake process through the goals of care, and treatment program staff are being altered significantly. Second, HIV brings with it a pull to extend the reach of drug abuse treatment to the sexual partners and families of patients. Finally, for community and statewide planners, a debate is emerging between the idea that programs should provide high-quality services to a few targeted "high risk" or "vital category" patients versus providing minimal services to as many drug abusers as possible. There is a vital need for research studies that will add data to the decision-making process, at both the policy and programmatic levels.

Contingent methadone delivery: effects on illicit-opiate use

This study examined the effects of contingent vs. non-contingent delivery of a methadone dose supplement on relapse to illicit opiate use in the context of a methadone outpatient detoxification program. Following a 3-week methadone stabilization period on 30 mg, patients (N = 39) were randomly assigned to a contingent, a non-contingent, or a control treatment group. All patients received identical gradual reductions in their assigned methadone dose. During the dose reduction period (weeks 4-11), members of the contingent (N = 13) and non-contingent groups (N = 13) could obtain daily methadone-dose supplements up to 20 mg, but contingent group members could obtain supplements only if their most recent urinalysis results were opiate negative. Control subjects (N = 13) did not have dose increases available. The contingent group presented significantly lower opiate-positive urines during weeks 8-11 (14% positive) of the detox than the non-contingent (38% positive) or control (50% positive) groups. Additionally, the availability of extra methadone improved treatment retention and increased clinic attendance above levels observed in the control group. The potential for further use of methadone's reinforcing properties in the treatment of opiate dependence is discussed.

Methadone in pregnancy: clinical-toxicological aspects

The authors describe their experience with methadone treatment in pregnancy. Thirteen abuser pregnant women were studied under defined obstetrical and toxicological protocol. Newborns were also included in this study. In some cases a complete adherence to therapeutic program, allowing labour under very low methadone dosage (5 mg/day), minimized toxicological neonatal risk. Withdrawal syndrome in newborns was well controlled pharmacologically. The role of the toxicological laboratory during clinical management of drug dependent pregnant women is also discussed.