784 Naturalistic Measurement of Sleep/Wake Disturbance in Adults Receiving Methadone Treatment for Opioid Use Disorder

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A305-A305
Author(s):  
Lillian Skeiky ◽  
Devon Hansen ◽  
Matthew Layton ◽  
Raymond Quock ◽  
Hans Van Dongen ◽  
...  
Keyword(s):  
Reference Data ◽  
Reference Group ◽  
Night Shift ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Shift Schedule ◽  
Sleep Continuity ◽  
Wake Patterns ◽  
Ks Test

Abstract Introduction Individuals with opioid use disorder (OUD) report significant sleep/wake disturbance, which continues even after stabilization on medication-assisted treatment (MAT). However, the nature of sleep/wake disturbance in this population has not been well documented objectively. Here we analyze naturalistic wrist actigraphy recordings in individuals with OUD receiving methadone-based MAT. Methods Seven adults undergoing methadone treatment for OUD (ages 26–50; 4 women) wore a wrist actigraph (Actiwatch-2, Philips Respironics) continuously for 7 days. They were asked to adhere to their normal sleep schedule in order to obtain naturalistic observations. Reference data were collected in a separate study of healthy controls, in which 14 hospital nurses (ages 20–60; 13 women) wore a wrist actigraph continuously for 7 days. In this reference group, 7 participants had a day shift schedule (07:00–19:00) and 7 had a night shift schedule (19:00–07:00), with six 12h shifts in a 2-week period. Actigraphic data were collected in 1min epochs, and the sleep/wake status for each epoch was estimated using Actiware 6.0.9 (Philips Respironics). The estimated sleep/wake patterns were subjected to cosinor analysis to assess 24h rhythmicity and analysis of the distribution of inactive periods to assess sleep continuity. Results For the reference group, nurses working day shifts displayed strong 24h rhythmicity, whereas nurses working night shifts showed blunted 24h rhythmicity (F[1,12]=66.11, p<0.001). However, both day and night nurses exhibited high sleep continuity (KS test, p=0.82). By contrast, for the group with OUD receiving methadone, the strength of 24h rhythmicity was reduced to between that of the day and night shift nurses in the reference group, indicating weak regularity of sleep/wake patterns (F[2,18]=33.79, p<0.001). Furthermore, individuals with OUD receiving methadone experienced low sleep continuity compared to the reference group (KS test, p=0.030). Conclusion These naturalistic observations confirm the presence of sleep/wake disturbance, resulting from both irregular sleep/wake patterns and low sleep continuity, in individuals receiving methadone-based MAT for OUD. Sleep/wake disturbance may interfere with the ability to achieve OUD recovery goals, and comparing sleep disturbance in MAT populations to reference data highlights the need to consider sleep in these populations as a clinical priority. Support (if any) State of Washington Initiative Measure No. 171

scholarly journals Cognitive profiles in persons with opioid use disorder enrolled in methadone treatment

2020 ◽  
pp. 1-7
Author(s):  
Victoria Sanborn ◽  
John Gunstad ◽  
Roman Shrestha ◽  
Colleen B. Mistler ◽  
Michael M. Copenhaver
Keyword(s):  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Cognitive Profiles ◽  
Opioid Use

scholarly journals Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph Tay Wee Teck ◽  
Alexander Baldacchino ◽  
Lauren Gibson ◽  
Con Lafferty
Keyword(s):  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Opioid Use ◽  
Access To Treatment ◽  
Medication Assisted Treatment ◽  
Low Threshold ◽  
Healthcare Innovation ◽  
Long Acting

Healthcare innovation has never been more important as it is now when the world is facing up to the unprecedented challenges brought by the COVID-19 pandemic. Within addictions services in Scotland, the priority has been to tackle our rising drug related death rate by maintaining and improving access to treatment while protecting frontline workers and managing operational challenges as a result of the pandemic. We present here a case study of five patients with opioid use disorder whose treatment represents a confluence of three important Medication Assisted Treatment (MAT) service innovations. The first was a low threshold drop in and outreach MAT service to rapidly and safely initiate opiate replacement therapy (ORT). The second was the provision of a microdosing regimen to enable same day induction to oral buprenorphine while minimizing the risk of precipitated opioid withdrawals and/or treatment disengagement. The third was rapid transitioning to an injectable long-acting buprenorphine depot which reduced unnecessary face to face patient contact and treatment non-adherence. This case study of five patients highlights the valuable role that buprenorphine microdosing can play in making induction to long-acting buprenorphine depot feasible to a broader range of patients, including those on a high dose methadone treatment regime.

scholarly journals Open-label dose-extending placebos for opioid use disorder: a protocol for a randomised controlled clinical trial with methadone treatment

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026604 ◽  
Author(s):  
Annabelle M Belcher ◽  
Thomas O Cole ◽  
Aaron D Greenblatt ◽  
Stephen W Hoag ◽  
David H Epstein ◽  
...  
Keyword(s):  
Placebo Effect ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Treatment Seeking ◽  
Personality Factors ◽  
Placebo Effects ◽  
Opioid Use ◽  
Open Label ◽  
University Of Maryland ◽  
Study Results

IntroductionMore than 2 million individuals in the USA have an opioid use disorder (OUD). Methadone maintenance treatment is the gold standard of medication-based treatment for OUD, but high-dose methadone is associated with cardiotoxicity and respiratory complications, among other side effects. These adverse effects make enhancing the effectiveness of lower doses of methadone an attractive therapeutic goal. Long recognised for its capacity to enhance treatment outcomes for a wide range of neuropsychiatric disorders including pain, the placebo effect offers an as-yet untested avenue to such an enhancement. This approach is particularly compelling given that individuals with substance use disorder tend to have higher salience attribution and may thereby be more sensitive to placebo effects. Our study combines two promising clinical methodologies—conditioning/dose-extension and open-label placebo—to investigate whether placebo effects can increase the effective potency of methadone in treatment-seeking OUD patients.Methods and analysisA total of 120 newly enrolled treatment-seeking OUD patients will be randomly assigned to one of two different groups: either methadone plus daily placebo dose-extension (PDE; treatment group) or methadone/treatment as usual (control). Participants will meet with study team members five times over the course of 3 months of treatment with methadone (baseline, 2 weeks, and 1, 2 and 3 months postbaseline). Throughout this study time period, methadone dosages will be adjusted by an addiction clinician blind to patient assignment, per standard clinical methods. The primary outcome is methadone dose at 3 months. Secondary outcomes include self-report of drug use; 3-month urine toxicology screen results; and treatment retention. Exploratory outcomes include several environmental as well as personality factors associated with OUD and with propensity to demonstrate a placebo effect.Ethics and disseminationHuman subjects oversight for this study is provided by the University of Maryland, Baltimore and University of Maryland, College Park Institutional Review Boards. Additionally, the study protocol is reviewed annually by an independent Data and Safety Monitoring Board. Study results will be disseminated via research conference presentations and peer-reviewed publications.Trial registration numberNCT02941809.

scholarly journals Correlates of sleep quality and excessive daytime sleepiness in people with opioid use disorder receiving methadone treatment

2020 ◽  
Vol 24 (4) ◽  
pp. 1729-1737
Author(s):  
Stephen R. Baldassarri ◽  
Mark Beitel ◽  
Andrey Zinchuk ◽  
Nancy S. Redeker ◽  
David E. Oberleitner ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Prenatal Methadone Exposure Disrupts Behavioral Development and Alters Motor Neuron Intrinsic Properties and Local Circuitry

2020 ◽  
Author(s):  
Gregory G. Grecco ◽  
Briana Mork ◽  
Jui Yen Huang ◽  
Corinne E. Metzger ◽  
David L. Haggerty ◽  
...  
Keyword(s):  
Motor Neuron ◽  
Pregnant Women ◽  
Methadone Maintenance ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Physical Growth ◽  
Opioid Use ◽  
Behavioral Assessments ◽  
Local Circuitry

ABSTRACTDespite the rising prevalence of methadone treatment in pregnant women with opioid use disorder, the effects of methadone on neurobehavioral development remain unclear. We developed a translational mouse model of prenatal methadone exposure (PME) that resembles the typical pattern of opioid use by pregnant women who first use oxycodone then switch to methadone maintenance pharmacotherapy, and subsequently become pregnant while maintained on methadone. We investigated the effects of PME on physical development, sensorimotor behavior, and motor neuron properties using a multidisciplinary approach of physical, biochemical, and behavioral assessments along with brain slice electrophysiology and in vivo magnetic resonance imaging. PME produced substantial impairments in offspring physical growth, activity in an open field, and sensorimotor milestone acquisition which were associated with alterations in motor neuron functioning and connectivity. The present study adds to the limited work examining PME by providing a comprehensive, translationally relevant characterization of how PME disrupts offspring development.

Methadone for Opioid Use Disorder

2020 ◽  
pp. 139-154
Author(s):  
Dennis J. Hand
Keyword(s):  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Long Term Treatment ◽  
Long Acting ◽  
Practical Factors

Methadone is a long-acting full opioid agonist that has a long history in the treatment of opioid use disorder (OUD). It was the first opioid agonist with OUD as an indication for use. Methadone was developed for OUD during a time of prohibition and criminalization of both addiction and the use of opioid agonists for addiction treatment, which resulted in methadone being heavily regulated at multiple levels. Methadone is frequently used in short-term withdrawal management (i.e., detoxification) and in long-term treatment, with the latter producing better treatment outcomes. This chapter explores the basic pharmacology of methadone and the development of methadone for OUD and its accompanying regulations, discusses the place of methadone in treatment for OUD, reviews the effectiveness of methadone treatment, and visits some practical factors related to methadone as part of treatment for OUD.

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