A treatment crisis: Cocaine use by clients in methadone maintenance programs

Kolar, Anne F.; Brown, Barry S.; Weddington, William W.; Ball, John C.

doi:10.1016/0740-5472(90)90005-b

Cited by 104 publications

(54 citation statements)

References 11 publications

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“…Despite its widespread use, there are few clinical reports describing interactions between methadone and other drugs. In addition to its use in treatment of opiate abuse (Jaffe, 1986;Martin, 1977), methadone itself has been abused (Bell et al, 1990;Kolar et al, 1990). Since the half-life of methadone in humans is about 23 h (Inturrisi et al, 1987), it will accumulate after multiple doses.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of human cytochrome P450 2D6 (CYP2D6) by methadone.

Wu¹,

Otton²,

Sproule³

et al. 1993

Brit J Clinical Pharma

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1. In microsomes prepared from three human livers, methadone competitively inhibited the O‐demethylation of dextromethorphan, a marker substrate for CYP2D6. The apparent Ki value of methadone ranged from 2.5 to 5 microM. 2. Two hundred and fifty‐two (252) white Caucasians, including 210 unrelated healthy volunteers and 42 opiate abusers undergoing treatment with methadone were phenotyped using dextromethorphan as the marker drug. Although the frequency of poor metabolizers was similar in both groups, the extensive metabolizers among the opiate abusers tended to have higher O‐demethylation metabolic ratios and to excrete less of the dose as dextromethorphan metabolites than control extensive metabolizer subjects. These data suggest inhibition of CYP2D6 by methadone in vivo as well. 3. Because methadone is widely used in the treatment of opiate abuse, inhibition of CYP2D6 activity in these patients might contribute to exaggerated response or unexpected toxicity from drugs that are substrates of this enzyme.

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Section: Discussionmentioning

confidence: 99%

Inhibition of human cytochrome P450 2D6 (CYP2D6) by methadone.

Wu¹,

Otton²,

Sproule³

et al. 1993

Brit J Clinical Pharma

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“…A possible additional complication occurs when cocaineabusing opiate addicts enter methadone maintenance programs (Kolar et al, 1990). Methadone is a long-acting mu-opioid receptor agonist that is widely used for the treatment of opiate addiction (Kleber, 2003), and that has been demonstrated repeatedly to reduce opiate cravings and use (Greenwald, 2002;Joseph et al, 2000;Kling et al, 2000;Kreek, 1992b;Maxwell and Shinderman, 1999;Stimmel and Kreek, 2000).…”

Section: Introductionmentioning

confidence: 99%

Methadone Maintenance Reduces Heroin- and Cocaine-Induced Relapse without Affecting Stress-Induced Relapse in a Rodent Model of Poly-Drug Use

Leri

Tremblay

Sorge

et al. 2004

Neuropsychopharmacol

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Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine-and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.

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“…Finally, the prevalence rate for cocaine use has been reported to be approximately 0.6% or 1.5 million users [6]. Cocaine is either snorted or injected intravenously in its hydrochloride salt form or smoked in a rock form commonly referred to as "crack cocaine" [85,86].…”

Section: Stimulantsmentioning

confidence: 99%

“…Cocaine use amongst patients undergoing methadone maintenance for heroin use disorder is also a commonly observed problem [86]. One study [86] examined the toxicology reports of eleven methadone maintenance programs and their 2,414 clients in the Baltimore, Maryland, area finding that between 5.9% to 33.0% of clients tested positive for cocaine in the 30 days leading up to the study .…”

Section: Special Considerationsmentioning

confidence: 99%

“…One study [86] examined the toxicology reports of eleven methadone maintenance programs and their 2,414 clients in the Baltimore, Maryland, area finding that between 5.9% to 33.0% of clients tested positive for cocaine in the 30 days leading up to the study . Of all 3,655 incoming methadone maintenance clients, 47.9% reported having "problems" with cocaine.…”

Section: Special Considerationsmentioning

confidence: 99%

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