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Source: @methadoneUSA April 26, 2016 at 10:15AM
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Methadone maintenance found to be effective in use against heroin addiction

Check out this old video by the New York Times:

Methadone maintenance found to be more effective in treating heroin addiction than 180 day detoxific

Methadone maintenance is more effective in reducing heroin use among addicts
than a 180 -day detoxification program that included an array of counseling
services, a UC San Francisco study has found.


The objective of the study was to compare methadone maintenance-a widely used
but controversial method of weaning heroin addicts off the drug—with an
alternative treatment of psychosocially enriched 180 day methadone assisted
detoxification. Methadone maintenance resulted in lower heroin use rates and
fewer drug- related HIV risk behaviors, such as sharing needles. The study
results will be published in the March 8 issue of the Journal of the American
Medical Association.




“Methadone maintenance is controversial,” said Sharon Hall, PhD, lead author of
the study and UCSF professor in residence and vice-chair of psychiatry. “People
don’t like it because it is continued provision of an addicting drug. When
people come on methadone maintenance, they may stay on it for several years.
The idea of the study was to do a comparison to find a method that was as
effective but didn’t involve indefinite treatment with an addicting drug.”


Methadone maintenance has been used to treat heroin addiction since 1964, Hall
said. Heroin is a short- acting opiate, Hall explained, meaning it produces a
high and a withdrawal effect rapidly. Methadone is a slower acting—and
legal—opiate. It works by stabilizing heroin users so that they do not have a
heroin -induced euphoria or suffer from severe withdrawal symptoms.


The study enrolled 179 participants who were assessed monthly for a year. A
urine specimen was collected each time.


Those in the methadone maintenance part of the study received stable doses of
methadone. Participants also attended one hour per week of substance abuse
group therapy for the first six months and one hour per month of individual


Those in the 180 -day detoxification program received 120 days of methadone
treatment, followed by 60 days of methadone dose reduction until they were no
longer taking methadone. They also received a host of drug counseling services.
During the first six months, participants were required to attend two hours per
week of substance abuse group therapy, one hour per week of cocaine group
therapy if they were found to also be addicted to that drug, and a series of
one- hour substance abuse education classes held weekly. They also attended
weekly individual therapy sessions. During the last seven months of the study,
participants were offered aftercare treatment that included weekly individual
and group psychotherapy and liaison services with the criminal justice system,
medical clinics and social service agencies.


Read the full post here:

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Vivitrol Treatment for Opioid-addicted Criminal Justice Offenders


Naltrexone, an oral opioid blocker, is now available as an extended-release monthly injection, under the brand name Vivitrol. Initially marketed for alcohol addiction, it also treats opioid addiction. This medication is an opioid antagonist, which means that though it attaches to opioid receptors, it does not stimulate the receptor. Since naltrexone has a higher affinity for the receptor than opioid agonists (like oxycodone, heroin, and methadone) it can’t be displaced. This means it blocks opioid effects, including euphoria. Vivitrol is used for alcohol addiction because part of the pleasure from alcohol consumption is thought to be mediated through opioid receptors.

Some patients say Vivitrol blocks opioid cravings. From a purely biological view, that would be surprising, since it does not stimulate the opioid receptor. Yet some studies suggest it reduces opioid cravings, and some patients claim it reduces opioid cravings. It’s hard to know if this is due to a physiologic effect, or a mental process. If a patient who has just been given an opioid blocker believes he then is unable to feel any euphoria from opioids, maybe his cravings diminish.

I haven’t used Vivitrol much. I had one patient who came two months in a row for his injection, then was lost to follow up. I’ve had about three prospective Vivitrol patients scheduled to see me in my office and all three were no-shows for their appointments, very irritating.

This medication is expensive, at over a thousand dollars for one monthly injection.

In short, from the studies I’ve read and my own experience, I’m not convinced naltrexone will ever be as effective as methadone or buprenorphine in the treatment of opioid addiction.

When I saw an article in the New England Journal of Medicine, titled “Extended-release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders,” I read it with interest. This article was in the March 31, 2016 issue, describing a study of 308 subjects, done by Lee et al., at five sites in the Northeast.

The study subjects were recruited from volunteers with histories of opioid dependence who were involved with the criminal justice system, but not incarcerated. These people agreed to be randomized to the treatment with Vivitrol or treatment as usual. Subjects were excluded if they had elevated liver function tests, were pregnant or trying to become pregnant, or had serious physical or mental health problems. They were also excluded if they had a chronic pain diagnosis for which opioids were prescribed, or if they had been hospitalized with a drug overdose within the past 3 years. They were excluded from the study if they preferred addiction treatment with buprenorphine or methadone medications, since obviously naltrexone can’t be given with those two medications.

The test subjects randomized to the Vivitrol group received injections every 4 weeks with counseling around medication side effects. Beyond that, both the Vivitrol group and the treatment as usual group had similar counseling schedules. People in the treatment as usual group were referred to treatment programs in the community, including providers of methadone and buprenorphine. Test subjects were seen every two weeks for 24 weeks, then at week 27, 52, and 78. Urine toxicology was obtained at each visit, as was self-report of drug use. Researchers also collected subject-reported data about criminal activity, re-arrest and incarceration.

The study examined how long it took subjects in each group to relapse to opioid use. The researchers defined relapse as ten or more days of opioid use out of the preceding four weeks. The rate of opioid-free drug screens was also evaluated for each group.


Read the rest of the article here: Vivitrol Treatment for Opioid-addicted Criminal Justice Offenders