Subjective Symptoms and Serum Methadone Concentration: What Should Guide Dose Adjustments in Methadone Maintenance Treatment? A Naturalistic Cohort Study From Norway

Abstract BackgroundThere is little evidence-based guidance on how to optimize methadone dosage 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 concentration and what role these could play in clinical decisions on dose adjustments.MethodsIn this naturalistic cohort study clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway during May 2017-January 2020 were included. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms (SOWS), self-reported adverse effects and substance use were obtained. Linear mixed modelling was used for analyzing the data.ResultsMean age was 45 years and 34% were women. 55% reported subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. Self-reported substance use was recorded in 88% of the interviews. Total SOWS score (P<0.001), and the specific subjective withdrawal symptoms of anxiety (P=0.004), bone- and muscle ache (P=0.003), restlessness (P=0.017) and shaking (P=0.046) out of the 16 symptoms in standard SOWS questionnaire, as well as the use of heroin (P=0.015) and alcohol (P=0.011) were associated with lower methadone concentrations, whereas cannabis use was associated with higher methadone concentrations (P=0.049). Conclusions More subjective opioid withdrawal symptoms and more self-reported use of heroin and alcohol were associated with lower serum methadone concentrations. More use of cannabis was related to higher serum methadone concentrations. These findings suggest that patient's self-perceived symptoms and current clinical condition can be applied as the main guide in methadone dose adjustments. In some aberrant cases, measurement of serum concentration together with other individual assessments may be considered to support the clinical decision.

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

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00367-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Fatemeh Chalabianloo ◽

Lars Thore Fadnes ◽

Gudrun Høiseth ◽

Christian Ohldieck ◽

Jørn Henrik Vold ◽

...

Keyword(s):

Substance Use ◽

Cohort Study ◽

Adverse Effects ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Opioid Withdrawal ◽

Withdrawal Symptoms ◽

Serum Concentrations ◽

Patient Reported

Abstract 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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Gender differences in substance use patterns and disorders among an Iranian patient sample receiving methadone maintenance treatment

Electronic physician ◽

10.19082/5354 ◽

2017 ◽

Vol 9 (9) ◽

pp. 5354-5362 ◽

Cited By ~ 13

Author(s):

Amir Ghaderi ◽

Maryam Motmaen ◽

Iraj Abdi ◽

Morad Rasouli-Azad

Keyword(s):

Gender Differences ◽

Substance Use ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Iranian Patient ◽

Patient Sample ◽

Use Patterns

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The relationship between self-reported substance use and psychiatric symptoms in low-threshold methadone maintenance treatment clients

Harm Reduction Journal ◽

10.1186/1477-7517-8-18 ◽

2011 ◽

Vol 8 (1) ◽

pp. 18 ◽

Cited By ~ 4

Author(s):

Heather G Fulton ◽

Sean P Barrett ◽

Cindy MacIsaac ◽

Sherry H Stewart

Keyword(s):

Substance Use ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Psychiatric Symptoms ◽

Low Threshold ◽

The Relationship

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Associations between methadone maintenance treatment and crime: a 17-year longitudinal cohort study of Canadian provincial offenders

Addiction ◽

10.1111/add.14059 ◽

2017 ◽

Vol 113 (4) ◽

pp. 656-667 ◽

Cited By ~ 17

Author(s):

Angela Russolillo ◽

Akm Moniruzzaman ◽

Lawrence C. McCandless ◽

Michelle Patterson ◽

Julian M. Somers

Keyword(s):

Cohort Study ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Longitudinal Cohort Study ◽

Longitudinal Cohort

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High levels of opioid analgesic co-prescription among methadone maintenance treatment clients in British Columbia, Canada: Results from a population-level retrospective cohort study

American Journal on Addictions ◽

10.1111/j.1521-0391.2014.12091.x ◽

2014 ◽

Vol 23 (3) ◽

pp. 257-264 ◽

Cited By ~ 15

Author(s):

Bohdan Nosyk ◽

Benedikt Fischer ◽

Huiying Sun ◽

David C. Marsh ◽

Thomas Kerr ◽

...

Keyword(s):

British Columbia ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Methadone Maintenance Treatment ◽

Retrospective Cohort ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Opioid Analgesic ◽

Population Level

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Exploring the relationship between perceived inter-dose opioid withdrawal and patient characteristics in methadone maintenance treatment

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2009.07.003 ◽

2009 ◽

Vol 105 (3) ◽

pp. 209-214 ◽

Cited By ~ 11

Author(s):

Alex K. Elkader ◽

Bruna Brands ◽

Russell Callaghan ◽

Beth A. Sproule

Keyword(s):

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Patient Characteristics ◽

Opioid Withdrawal ◽

The Relationship

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Perceptions of Problem Gambling Among Methadone Maintenance Treatment Clients and Counsellors

Journal of Gambling Issues ◽

10.4309/jgi.2018.40.3 ◽

2018 ◽

Author(s):

Megan E Wall ◽

Cassandra R Durand ◽

Hana Machover ◽

Rachel Arnold ◽

Haley A Miles-McLean ◽

...

Keyword(s):

Substance Use ◽

Problem Gambling ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Negative Impact ◽

Treatment Options ◽

Current Treatment ◽

Treatment Programs ◽

Structured Interviews

Problem gambling is highly prevalent and rarely treated among clients who attend methadone maintenance treatment programs (MMTPs). Compared with those of the general population, rates of gambling disorder have been found to be elevated among individuals receiving methadone maintenance treatment. Our study aims were to (a) develop a clearer understanding of the gambling experience of clients and counsellors at a methadone clinic and (b) gain insight into the current treatment options and obstacles to treatment in the clinic. Semi-structured interviews focusing on gambling issues were conducted with 8 clients and 8 counsellors at an MMTP located in an urban area. Participants were asked questions to gain an understanding about their perspectives on, treatment options for, and treatment barriers to problem gambling in the clinic. Data were coded by 4 investigators by using a constant comparison, open coding approach. The findings revealed important differences between clients and counsellors: Opinions differed on the definition of problem gambling, obstacles to treatment, and optimal treatment settings. Clients and counsellors also agreed on some elements, including the negative impact that problem gambling can have on recovery from substance use. This examination of responses of counsellors and client feedback provides a useful mechanism to better understand problem gambling in MMTPs. In addition, the findings have important clinical implications, including a need for more effective screening and treatment in MMTPs and to provide substance use counsellors with training related to problem gambling.RésuméLe jeu compulsif est hautement répandu et rarement traité parmi les clients qui suivent un programme de traitement d’entretien à la méthadone. Comparés à ceux de la population en général, les taux de jeu pathologique ont jugé élevés chez les personnes qui suivent un tel traitement. Les objectifs de notre étude étaient de deux ordres : a) mieux comprendre l’expérience de jeu des clients et les connaissances en cette matière des conseillers d’une clinique de traitement à la méthadone, et b) avoir une meilleure compréhension des options de traitement actuelles et des obstacles au traitement en clinique. Des entretiens semi-structurés portant sur les problèmes de jeu ont été menés auprès de 8 clients et de 8 conseillers dans un centre de traitement, situé en zone urbaine. On a posé des questions aux participants pour mieux comprendre leurs points de vue sur les options et les obstacles au traitement contre le jeu problématique à la clinique. Les données ont été codées par quatre chercheurs en utilisant une approche de codification ouverte à comparaison constante. Les résultats ont révélé des différences importantes entre les clients et les conseillers : les opinions divergeaient quant à la définition du jeu problématique, les obstacles au traitement et les paramètres de traitement optimaux. Les clients et les conseillers ont par ailleurs été d’accord sur certains éléments, notamment l’impact négatif que le jeu problématique peut avoir sur le rétablissement d’une consommation abusive. L’examen des réponses des conseillers et des commentaires des clients constitue un mécanisme efficace pour mieux comprendre le jeu problématique dans les programmes de traitement d’entretien à la méthadone. De plus, les résultats ont d’importantes répercussions cliniques, notamment la nécessité d’un dépistage et d’un traitement d’entretien à la méthadone plus efficaces et d’une formation sur le jeu problématique pour les conseillers en toxicomanie.

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