Maintenance Medication for Opiate Addiction: The Foundation of Recovery

In the paper

“Historical data indicate poor outcome in patients provided only psychosocial interventions. Whether compelled or voluntary, return to opiate use approaches 80% within two years of intensive residential treatment.”

What the sources say

• Not checked yetcites [36] Pescor M J, 1943, Publ Health Rep
• Not checked yetcites [37] Vaillant G E, 1973, Arch Gen Psychiatry source

In the paper

“Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function.”

In the paper

“Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world.”

What the sources say

• Not checked yetcites [9]
• Not checked yetcites [11] Substance Abuse and Mental Health Services Administration. 2011. “Treatment episode data set”. http://www.dasis.samhsa.gov/webt/quicklink/us09.htm(accessed December 21, 2011).

In the paper

“The addiction liability of opiates is high with 50% and 11% of people who used heroin or prescription opiates, respectively, last year meeting addiction criteria.”

What the sources say

• Not checked yetcites [12] Substance Abuse and Mental Health Services Administration. 2011. “National survey on drug use and health 2010”. http://www.icpsr.umich.edu/cgi-bin/SDA/SAMHDA/hsda?samhda+32722-0001(accessed December 21, 2011)

In the paper

“a separate review found that psychosocial intervention alone was inferior to methadone maintenance for such outcomes as retention in treatment and reduction in opiate positive urine toxicology tests”

What the sources say

• Not checked yetcites [39] Mattick R P, 2003, Cochrane Database Syst Rev

In the paper

“not only did methadone relieve opiate withdrawal but, when at steady-state, it also blocked the euphoric and sedating effects of superimposed opiates”

What the sources say

• Not checked yetcites [60] Dole V P, 1966, Arch Intern Med source
• Not checked yetcites [61] Dole V P, 1965, JAMA source

In the paper

“One randomized trial comparing each of the medications found 24-week retention rates of 84%, 59%, and 21% for methadone 50mg, buprenorphine 5mg, and naltrexone 50mg, respectively, despite suboptimal doses of methadone and buprenorphine.129”

What the sources say

• Not checked yetcites [129] Ahmadi J, 2003, Eur J Clin Invest source

In the paper

“naltrexone is without intrinsic opiate activity and poses minimal risk abuse or diversion”

In the paper

“Naltrexone’s effect on craving in opiate addicts is less clear. Oral naltrexone may not reduce craving more than placebo and if it does, this reduction does not necessarily correlate with abstinence.”

What the sources say

• Not checked yetcites [124] Krupitsky E M, 2006, J Subst Abuse Treat source
• Not checked yetcites [125] Dijkstra B AG, 2007, Addiction Biology source

In the paper

“Failure of oral naltrexone to prevent relapse in opiate addicts may be related to ongoing stress dysregulation and is supported by animal research showing its failure to suppress stress-induced relapse.”

What the sources say

• Not checked yetcites [126] Shaham Y, 1997, J Neurosci. source

In the paper

“These studies have shown retention of approximately 60% at 6-months, exceeding that of oral naltrexone.”

What the sources say

• Not checked yetcites [119] Hulse G K, 2009, Arch Gen Psychiatry source
• Not checked yetcites [120] Kunøe N, 2009, Br J Psychiatry source

In the paper

“While methadone will increase the electrocardiographic QTc interval, this appears minimal in magnitude and rarely exceeds the 500 msec threshold associated with cardiac arrhythmia and sudden death in those with heart disease.”

What the sources say

• Not checked yetcites [55] Martin J A, 2011, J Addict Dis source
• Not checked yetcites [56] Martell B A, 2005, Am J Cardiol source

In the paper

“Methadone, buprenorphine, and naltrexone are each FDA approved for the long-term treatment of opiate addiction”

In the paper

“many of buprenorphine’s effects plateau after approximately 16 mg, although doses of up to 32mg are used clinically”

What the sources say

• Not checked yetcites [84] Walsh S L, 1994, Clin Pharmacol Ther source

In the paper

“the literature on its use in the treatment of alcoholism where it reduces craving, a frequent predecessor to relapse. In fact, reduction in base-line craving is correlated with its effectiveness.”

What the sources say

• Not checked yetcites [123] Volpicelli J R, 1995, J Clin Psychiatry

In the paper

“Mean 1-year retention in treatment is approximately 60% and can vary based on adherence to evidence-based dosing practices.”

What the sources say

• Not checked yetcites [64] Johnson R E, 2000, N Engl J Med source
• Not checked yetcites [65] Strain E C, 1999, JAMA source
• Not checked yetcites [66] Ling W, 1996, Arch Gen Psychiatry source

In the paper

“Whereas both methadone and buprenorphine can normalize stress response, naltrexone maintenance may not.”

In the paper

“Buprenorphine’s ability to both induce and relieve opiate withdrawal was observed by Martin et al. in 1976”

What the sources say

• Not checked yetcites [88] Martin W R, 1976, J Pharmacol Exp Ther source
• Not checked yetcites [89] Jasinski D R, 1978, Arch Gen Psychiatry source

In the paper

“Regulation of stress response is one such function that tends to normalize with methadone stabilization.”

What the sources say

• Not checked yetcites [52] Kreek M J, 1973, JAMA source
• Not checked yetcites [76] Kreek M J, 1983, Life Sci source
• Not checked yetcites [77] Facchinetti F, 1984, Acta Endocrinol Copenh source

In the paper

“It appears that most stress responsive markers are normalized in buprenorphine maintained patients and that failure to normalize correlates with craving and relapse.”

What the sources say

• Not checked yetcites [103] Kakko J, 2008, Biol Psychiatry source
• Not checked yetcites [104] Fatseas M, 2011, Biol Psychiatry source

In the paper

“Methadone response appears to be dose related with most patients stabilizing at doses between 60mg–120mg daily.”

What the sources say

• Not checked yetcites [62] National Institutes of Health, 1998, JAMA source

In the paper

“Buprenorphine is a semi-synthetic mu opioid partial agonist with weak partial agonist effects at both delta and kappa opioid receptors.”

What the sources say

• Not checked yetcites [79] Bentley K W, 1967, J Am Chem Soc source

In the paper

“Its antagonist effect can be overridden in setting of acute pain but caution is advised.138”

What the sources say

• Not checked yetcites [138] Gastfriend D R, 2011, Ann N Y Acad Sci source

In the paper

“Since methadone does not have active metabolites, patients may experience early withdrawal and may require increases in or splitting of methadone dose during the second and third trimesters.133”

What the sources say

• Not checked yetcites [133] Pond S M, 1985, J Pharmacol Exp Ther source

In the paper

“Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies.”

In the paper

“Since this will also increase methadone peak levels, it may result in sedation.”

In the paper

“this precedent does not extend to a specific medication”

What the sources say

• Not checked yetcites [142] Richard J, 2006, Journal of Substance Abuse Treatment source

In the paper

“Each can reduce recidivism and illicit opiate use.”

What the sources say

• Not checked yetcites [139] Kinlock T W, 2009, J Subst Abuse Treat source
• Not checked yetcites [140] Magura S, 2009, Drug Alcohol Depend source

In the paper

“Several reports comparing short-term detoxification to buprenorphine maintenance, however, show better results with longer periods of medication and high rates of relapse following discontinuation of medication.(for a review see 136)”

What the sources say

• Not checked yetcites [136]

In the paper

“Increased methadone clearance may result in onset of withdrawal symptoms and can be prevented by increasing methadone dose.”

In the paper

“the length, but not intensity, of neonatal abstinence syndrome and the neonates’ need for morphine relief was lower in women taking buprenorphine compared to methadone”

What the sources say

• Not checked yetcites [134] Jones H E, 2010, N Engl J Med source