Cognitive Functioning under Moderate and Low Dosage Methadone Maintenance

Lombardo, William K.; Lombardo, Barbara; Goldstein, Avram

doi:10.3109/10826087609056158

Cited by 45 publications

(15 citation statements)

References 18 publications

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“…These have included impairments in cognitive flexibility [22,23], in strategic planning [24,25] and decision making [26]. Other studies found no clear deficits when comparing the performance of healthy controls, with that of opioid abstinent or methadone users [27,28]. The accumulated literature tends to assume that neuropsychological function is commonly impaired as a consequence of chronic methadone use justifying an abstinence agenda with premature termination of methadone treatment [29].…”

Section: Introductionmentioning

confidence: 99%

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

et al. 2014

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BackgroundIt is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.MethodsQuantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.ResultsThere were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.ConclusionsChronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes.

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Section: Introductionmentioning

confidence: 99%

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

et al. 2014

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“…However, Bracken et al (2012) found faster speed on a continuous performance task for higher dose MMP, but no group differences were found on DSST performance. Other studies found no effects of maintenance dose on cognitive performance (Darke, et al, 2000; Lombardo, et al, 1976; Soyka, et al, 2005). To our knowledge, the current study is the first to evaluate the effects of maintenance dose level as a function of time relative to methadone dosing (peak vs. trough session).…”

Section: Discussionmentioning

confidence: 85%

Cognitive performance in methadone maintenance patients: Effects of time relative to dosing and maintenance dose level.

Rass¹,

Kleykamp²,

Vandrey³

et al. 2014

Experimental and Clinical Psychopharmacology

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Given the long-term nature of methadone maintenance treatment, it is important to assess the extent of cognitive side effects. This study investigated cognitive and psychomotor performance in fifty-one methadone maintenance patients (MMP) as a function of time since last methadone dose and maintenance dose level. MMP maintained on doses ranging from 40 to 200 mg (Mean = 97 mg) completed a battery of psychomotor and cognitive measures across two sessions, during peak and trough states, in a double-blind crossover design. Peak sessions were associated with worse performance on measures of sensory processing, psychomotor speed, divided attention, and working memory, compared to trough sessions. The effects of maintenance dose were mixed, with higher dose resulting in worse performance on aspects of attention and working memory, improved performance on executive function, and no effects on several measures. Longer treatment duration was associated with better performance on some measures, but was also associated with increased sensitivity to time since last dose (i.e., worse performance at peak vs. trough) on some measures. The results suggest that cognitive functioning can fluctuate as a function of time since last dose even in MMP who have been maintained on stable doses for an extended time (mean duration in treatment = 4 years), but worsened performance at peak is limited to a subset of functions and may not be clinically significant at these modest levels of behavioral effect. For patients on stable methadone maintenance doses, maintenance at higher doses may not significantly increase the risk of performance impairment.

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“…Several studies have contradicted these findings (e.g. Lombardo et al 1969) and at least cognitive and psychological functioning is normal in cancer patients receiving such drugs; they rapidly develop tolerance to the initial cognitive impairment during use of opioids (Bruera et al 1989). In summary, the available literature permits no final conclusion on subtle neuropsychological impairment as a consequence of long term opioid use.…”

Section: Systemic Toxicitymentioning

confidence: 93%

Adverse Effects of Systemic Opioid Analgesics

Schug¹,

Zech²,

Grond³

1992

Drug Safety

142

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Adverse effects of opioids are multiple. They are most often receptor-mediated and inseparable from their desired effects. The most severe mishaps with opioids are related to their respiratory depressant effect, which is widely influenced by factors such as pain, previous opioid experience and awareness. Other relevant central nervous system effects of opioids include cough suppression, nausea and vomiting, rigidity, pruritus and miosis. The cardiovascular adverse effects of opioids are mainly related to histamine release and differ widely between agonists and agonist-antagonists. Gastrointestinal effects such as constipation, reflux and spasms of the bile duct are well described. Adverse effects on endocrine, immunological and haematological functions are possible, while allergic reactions are extremely rare. The adverse effects of long term use are overestimated. Systemic toxicity is negligible and development of tolerance is minimal while treating pain. In the clinical setting of pain control, addiction and withdrawal do not pose significant problems. Nevertheless, the possible effects of opioids on the unborn child should always be considered. Overall, opioids show a good record of safety. Their use should not be unduly limited by unfounded fears of adverse effects, but these effects should be avoided by anticipation and prevention.

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Cognitive Functioning under Moderate and Low Dosage Methadone Maintenance

Cited by 45 publications

References 18 publications

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

Cognitive performance in methadone maintenance patients: Effects of time relative to dosing and maintenance dose level.

Adverse Effects of Systemic Opioid Analgesics

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