Modulation of Attentional Bias to Drug and Affective Cues by Therapeutic and Neuropsychological Factors in Patients With Opioid Use Disorder on Methadone Maintenance Therapy

Objective: Abnormal selective attention to drug cues and negative affect is observed in patients with substance dependence, and it is closely associated with drug addiction and relapse. Methadone maintenance is an effective replacement therapy to treat heroin addiction, which significantly reduces the relapse rate. The present study examines whether the patients with opioid use disorder on chronic methadone maintenance therapy exhibit abnormal attentional bias to drug cues and negative-affective cues. Moreover, its relation to therapeutic and neuropsychological factors is also examined.Methods: Seventy-nine patients with opioid use disorder under chronic methadone maintenance therapy and 73 age-, sex-, and education-matched healthy controls were recruited and assessed for attentional bias to drug cues and negative affect using a dot-probe detection task. Correlational analysis was used to examine the relationships between the attentional bias and the demographic, therapeutic, and neuropsychological factors.Results: No significant overall patient-control group difference is observed in drug-related or negative-affective-related attentional bias scores. In the patient group, however, a significant negative correlation is found between the attentional bias scores to negative-affective cues and the duration of methadone treatment (p = 0.027), with the patients receiving longer methadone treatment showing less attentional avoidance to negative-affective cues. A significant positive correlation is found between the negative affect-induced bias and the impulsivity score (p = 0.006), with more impulsive patients showing higher attentional avoidance to negative affective cues than less impulsive patients. Additionally, the patients detect a smaller percentage of probe stimuli following the drug (p = 0.029) or negative-affective pictures (p = 0.009) than the healthy controls.Conclusion: The results of the present study indicate that the patients under chronic methadone maintenance therapy show normalized attentional bias to drug and negative-affective cues, confirming the involuntary attention of the patients is not abnormally captured by external drug or negative-affective clues. Our findings also highlight that the attentional avoidance of negative-affective cues is modulated by the duration of methadone treatment and the impulsivity level in the patients.

Impact of Prerelease Methadone on Mortality Among People with HIV and Opioid Use Disorder After Prison Release: Results from a Randomized and Participant Choice Open-Label Trial in Malaysia

Introduction: Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Opioid agonist therapy (OAT) with methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison. Methods:This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n=291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n=64) and participant choice (n=246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival. Results: Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5–89.4). Most deaths were of infectious etiology. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6–3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5–2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0–1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1–3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7–1.0). Conclusions: Mortality after prison release in this sample of men with HIV and OUD was extraordinarily high and unaffected by prerelease methadone. Treatment of OUD alone may be insufficient to reduce mortality in settings where inadequately treated HIV is the main cause of death after prison release. Trial registration number: NCT02396979. Retrospectively registered 24/03/2015.

Addiction Treatment as Prison Governance: A Critical Discourse Analysis of Methadone Delivery in Kyrgyz Prisons

Methadone treatment is prescribed by evidence-based medicine as the most effective tool for the treatment of opioid addiction. Its implementation into high-need prison settings worldwide has been met with challenges, particularly in Eastern Europe and Central Asia where the opioid epidemic continues to expand. To address these impasses to intervention translation, we turn to post-structural approaches to policy analysis. These approaches open space for (re)thinking the ways that translated interventions emerge locally, by treating policy texts as social practices that make interventions in specific, sometimes unexpected, ways. We leverage Carol Bacchi’s post-structuralist analytic framework to interrogate how the object of methadone is constituted in Kyrgyz prisons through an analysis of the national legislative document, the “Government Program,” which provides the legislative basis for opioid addiction treatment administration in the Kyrgyz Republic. Rather than the medicalized methadone for the treatment of opioid use disorder, contained in the distinct objectivization of methadone emerging from this policy text, is the previously unexamined assumption that methadone is a particular type of governance. We describe a methadone object tied up with the shifting social structures that govern Kyrgyz prisons, divided between formal (state-run) and informal (prisoner-run) governance. In Kyrgyz prisons, where opioid policy discourse produces a divide between formal and informal governance, methadone emerges as a tool of the formal prison administration to regain control of the prisons from the practices of prisoner subculture. Although this study takes the Kyrgyz case as an example, the enactment of methadone as formal governance is likely to resonate throughout Eastern Europe and Central Asia, where there is a strong legacy of self-governing prisons. We conclude with a call for global health policymakers to consider how opioid addiction treatment is constituted within local governing relations, in ways that may depart sharply from the evidence base.

Efficacy of group reality therapy versus desipramine pharmacotherapy in drug craving and relapse of methamphetamine-dependent patients in yazd

Aims: In this comparative study, we aimed to investigate the effectiveness of group reality therapy versus desipramine pharmacotherapy in reducing the craving and relapse of methamphetamine-dependent patients. Methods: This semi-experimental research was conducted using a control group and two experimental groups of reality therapy and desipramine pharmacotherapy. The statistical population of this study included all methamphetamine-dependent patients under methadone treatment who were referred to the health clinics of Yazd city, Iran. We selected 30 patients using convenience sampling and then categorized them randomly into three groups of reality therapy, desipramine pharmacotherapy, and control. In the pre-test stage, the risk questionnaire was administered to evaluate the stimulants. The first experimental group attended 10 reality therapy sessions once a weak and was assessed immediately after the treatment. The data were analyzed using the covariance analysis. Results: The findings showed no significant difference between the total mean score of the reality therapy and desipramine pharmacotherapy groups (F= 3.289, P= 0.087). Hence, these two interventions did not affect attenuating craving to use the drugs. To check the homogeneity presumptions of the covariance matrix and variances of the two groups, the Box (6.241) and Levine (0.250) tests were applied, respectively. The results about the experimental groups (Reality therapy and Desipramine group) compared to the control group were meaningful. Conclusion: There was no significant difference between reality therapy and desipramine pharmacotherapy groups in reducing the craving to use the drugs. The scope of changes showed that craving for drug consumption reduced in reality therapy (51.0) and desipramine pharmacotherapy (36.0) groups.

Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule

Background In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The “72-hour rule” allows non-OTP providers to administer methadone for emergency opioid withdrawal management while arranging ongoing care. Low-barrier substance use disorder (SUD) bridge clinics provide rapid access to buprenorphine but offer an opportunity to treat acute opioid withdrawal while facilitating OTP linkage. We describe the case of a patient with OUD who received methadone for opioid withdrawal in a bridge clinic and linked to an OTP within 72 h. Case presentation A 54-year-old woman with severe OUD was seen in a SUD bridge clinic requesting OTP linkage and assessed with a clinical opiate withdrawal scale (COWS) score of 12. She reported daily nasal use of 1 g heroin/fentanyl. Prior OUD treatment included buprenorphine-naloxone, which was only partially effective. Her acute opioid withdrawal was treated with a single observed oral dose of methadone 20 mg. She returned the following day with persistent opioid withdrawal (COWS score 11) and was treated with methadone 40 mg. On day 3, the patient was successfully admitted to a local OTP, where she remained engaged 3 months later. Conclusions While patients continue to face substantial access barriers, bridge clinics can play an important role in treating opioid withdrawal, building partnerships with OTPs to initiate methadone on demand, and preventing life-threatening delays to methadone treatment. Federal policy reform is urgently needed to make methadone more accessible to people with OUD.

Implementing a Methadone Delivery System in New York City in Response to COVID-19

Opioid agonist medication, including methadone, is considered the first-line treatment for opioid use disorder. Methadone, when taken daily, reduces the risk of fatal overdose; however, overdose risk increases following medication cessation. Amid an overdose epidemic accelerated by the proliferation of fentanyl, ensuring continuity of methadone treatment during the COVID-19 pandemic is a vital public health priority. (Am J Public Health. 2021;111(12):2115–2117. https://doi.org/10.2105/AJPH.2021.306523 )

Assessment of the Effectiveness of Matrix Model Among Methadone Patients Using ATS in Ho Chi Minh City, Vietnam

This study assessed the effectiveness of the application of the Matrix model in patients undergoing methadone treatment for Amphetamine-type substance (ATS) in Ho Chi Minh City. A total of 951 methadone patients were screened; 60 (16%) met the inclusion criteria and of those 51 (85%) completed 16 weeks of study procedures. Most of the participants were ATS users with moderate or higher risk of dependence. Compared to the non-intervention group, the intervention group showed a significant reduction in positive urine tests for methamphetamine (a decrease from 100% to 11% vs. a decrease from 100% to 98% for the non-intervention group, p<0.001) and for opiates (a decrease from 36.7% to 3.7% vs. a decrease from 43.3% to 29.2% for the non-intervention group). In the intervention group, the quality of life increased from 76.74 points to 85.5, the proportion of depression decreased from 43.3% to 18.5%, anxiety decreased from 30% to 11.1%, and stress decreased from 76.7% to 29.6%. In the non-intervention group, quality of life decreased from 75.2 points to 74.5 points, the proportion of depression decreased slightly from 40% to 36%, anxiety decreased from 33.3% to 24%, and stress decreased from 76.7% to 76.0%. The intervention group was significantly more likely to adhere to methadone treatment (p<0.001). The proportions of participants in the intervention group and non-intervention group who discontinued treatment were 10% and 20%, respectively. The study results suggested that the MATRIX model could help reduce ATS and opiate use and improve mental health as well as treatment adherence.