Methadone in Opioid Addiction Opium in San Francisco

Methadone in Opioid Addiction

Opium in San Francisco

OPIATES

Heroin 101

• New production in South America

• High purity/potency (smokeable)

• Detoxification is of limited long-term efficacy

• Most effective treatment for chronic users is Methadone Maintenance

• Medications

• Methadone Opioid Agonist Therapy
• Buprenorphine Partial Agonist Therapy
• Naltrexone Opioid Blockade

Heroin

• Short acting opiate

• Immediate effects:

• Heroin crosses the blood-brain barrier
• Heroin is converted to morphine and binds rapidly to opioid receptors
• Causes euphoria
• Pain relief
• Flushing of the skin
• Dry mouth
• Heavy feeling in the extremities

Heroin

• After initial effects:

• Drowsy for several hours.
• Clouded mental function
• Slowed cardiac function
• Slowed breathing
• Death by respiratory failure (overdose)

Opiate Addiction: Medications

• Detoxification

• Opioid Substitution
• Methadone (Agonist) [Illegal on outpatient basis]
• Buprenorphine (Partial Agonist) [Requires special DEA license]
• Non-Opioid Symptom Relief
• Clonidine / Lofexadine / Anti-spasmodic, anti-diarrheals / NSAIDS for bone pain and myalgia
• Sleep meds

• 95%+ poor outcome

Naltrexone: Efficacy vs. Effectiveness

• High Efficacy:

• An almost perfect, long-acting blocker of opiates

• Limited Effectiveness:

• Most effective in monitored treatment of medical or other professionals, executives, and individuals on probation
• Poor compliance in heroin-using population
• Poor treatment retention

Methadone Maintenance

Opiate Addiction: Maintenance

• Methadone

• Dole & Nyswander’s opioid deficiency theory (1964).
• Daily Dosing, Blocking dose usually > 60 mg qd

• Buprenorphine (formulated with or without naloxone)

• Partial Agonist (high opiate receptor avidity but low innate activity)
• Daily dosing, 2-32 mg qd

Impact of MMT on IV Drug Use for 388 Male MMT Patients in 6 Programs

Recent Heroin Use by Current Methadone Dose

Relapse to IV drug use after MMT 105 male patients who left treatment

Crime among 491 patients before and during MMT at 6 programs

Death Rates in Treated and Untreated Addicts

Summary of Methadone Maintenance Outcomes

• Gold-Standard for Opioid Treatment

• One of the most over-proven treatments in entire psychiatry and drug abuse literature
• Detoxification methods succeed only < 3% of the time.

• Outcomes Measures

• Reduction of …
• Death rates (8-10X reduction)
• Drug use
• Criminal activity
• HIV spread
• Increase in …
• Employment
• Social stability
• Retention, medication compliance, and monitoring