Double jeopardy: a review of weight gain and weight management strategies for psychotropic medication prescribing during methadone maintenance treatment

Abstract

Methadone maintenance treatment (MMT) is an important treatment tool for the opioid epidemic. One challenge is that many persons who present for MMT also have co-occurring psychiatric disorders. Individually, both methadone and psychiatric medications carry risk of weight gain. Therefore, concurrent prescribing of methadone and psychiatric medications places dual diagnosis patients at even greater risk. As a parallel obesity epidemic grows, results from clinical trials assessing weight gain and weight management strategies among MMT and psychiatric patients can both inform and guide clinical practice. Here, we review findings from a literature search for recent clinical trials that focused on weight gain and weight management strategies during MMT with concurrent psychotropic medication use. While several studies have documented weight gain during MMT and psychotropic medication treatment, we failed to identify recent work that explored concurrent prescribing. Most weight management strategies involved the use of additional medications and available data suggests that MMT and concurrent use of psychotropic medications increases the risk for obesity. More robust research is needed on weight gain and potential mitigation strategies when these treatment modalities are jointly utilized. Clarification of underlying biological mechanisms and development of non-pharmacological interventions merit further consideration.

Toward precision prescribing for methadone: Determinants of methadone deposition

“…Although our data are cross-sectional, study participants were on long-term, steady-state methadone. Additionally, methadone has been shown to result in medication-induced weight gain [65]. We did not observe a relationship between either fibrosis or steatosis and methadone concentration or metabolism.…”

Patterns and Determinants of Weight Gain among People Who Use Drugs Undergoing Treatment for Recovery in Lebanon

“…Finally, the majority of the participants who were initially obese maintained their status. Peles et al [ 55 ] and Sweeney et al [ 29 ] reported an increase in the number of patients classified as overweight or obese, and a decrease in the number of patients classified as normal weight nine months post admission to MMT, which supports our findings. Moreover, Montazerifar et al [ 54 ] showed that the percentage of patients in MMT who were initially categorized as being overweight or obese remained as such after eight weeks of treatment.…”

“…Weight gain during MMT (MMT) may be directly attributed to methadone itself [ 9 ]. Exposure in opiate agonists is associated with a shift in dietary preferences towards sweet and fatty foods [ 29 ], as well as glycemic control derangement [ 30 ].…”

Pharmacogenetic study of methadone treatment for heroin addiction: associations between drug-metabolizing gene polymorphisms and treatment efficacy

“…Furthermore, weight gain among patients is a common phenomenon during MMT [26][27][28]. Therefore, even underweight individuals may experience a gradual increase in their BMI reaching the level of overweight or obese individuals during the MMT, and this may become an underlying risk during long-term methadone treatment [28,29]. According to our results, an increase in the methadone dose may be concurrent with a BMI of >25.…”