Fortnightly Review: Methadone maintenance treatment in opiate dependence: a review

Farrell, Michael; Ward, Jodie; Mattick, Richard P.; Hall, Wayne; Stimson, Gerry V.; Jarlais, Des; Gossop, Michael; Strang, John

doi:10.1136/bmj.309.6960.997

Cited by 360 publications

(195 citation statements)

References 73 publications

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“…Shi et al (2008) first documented the reduced DAT uptake of [ 11 C] CFT in striatum of patients with prolonged heroin abstinence in comparison with healthy control subjects. Further, in comparison to the prolonged heroin abstinence subjects, the methadone (a synthetic opioid with long duration of action on opioid receptors (Farrell et al, 1994)) maintenance treatment subjects also showed significant decreases of DAT uptake function in the bilateral putamen. These findings suggest that chronic opioid use induces long-lasting striatum DA neuron impairment (Fig.…”

Section: Role Of Da In the Long-term Effects Of Heroin Abuse And Addimentioning

confidence: 98%

Positron Emission Tomography Molecular Imaging of Dopaminergic System in Drug Addiction

Hou¹,

Tian²,

Zhang³

2012

The Anatomical Record

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Dopamine (DA) is involved in drug reinforcement, but its role in drug addiction remains unclear. Positron emission tomography (PET) is the first technology used for the direct measurement of components of the dopaminergic system in the living human brain. In this article, we reviewed the major findings of PET imaging studies on the involvement of DA in drug addiction, especially in heroin addiction. Furthermore, we summarized PET radiotracers that have been used to study the role of DA in drug addiction. To investigate presynaptic function in drug addiction, PET tracers have been developed to measure DA synthesis and transport. For the investigation of postsynaptic function, several radioligands targeting dopamine one (D1) receptor and dopamine two (D2) receptor are extensively used in PET imaging studies. Moreover, we also summarized the PET imaging findings of heroin addiction studies, including heroin-induced DA increases and the reinforcement, role of DA in the long-term effects of heroin abuse, DA and vulnerability to heroin abuse and the treatment implications. PET imaging studies have corroborated the role of DA in drug addiction and increase our understanding the mechanism of drug addiction. Anat Rec, 295:722-733, 2012. V C 2012 Wiley Periodicals, Inc.Key words: positron emission tomography; dopamine; dopamine receptor; drug addiction; heroin BRAIN DOPAMINERGIC SYSTEM Dopamine (DA) is a catecholamine neurotransmitter in the nervous system that permits individual nerve fibers (neurons) to communicate with each other. DA has many functions in the brain, including important roles in behavior and cognition, voluntary movement, motivation, punishment and reward, sleep, mood, attention, working memory, and learning (Smythies, 2005).

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Section: Role Of Da In the Long-term Effects Of Heroin Abuse And Addimentioning

confidence: 98%

Positron Emission Tomography Molecular Imaging of Dopaminergic System in Drug Addiction

Hou¹,

Tian²,

Zhang³

2012

The Anatomical Record

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“…Even for diabetes, where the practice of regular recall is well known and in which the benefits of structured care have been established in the prison context itself (MacFarlane, Gill et al 1992), one quarter of prisons had no recall system. The low use of methadone maintenance therapy is worrying given the known benefits including reduction in mortality rates and incarceration rates (Farrell, Ward et al 1994) and needs addressing. The high level of mental health problems in prisoners (Birmingham 2003) Compared with small prisons, medium and larger prisons had a wider range of specialised services.…”

Section: Discussion Implicationsmentioning

confidence: 99%

A survey of primary and specialised health care provision to prisons in England and Wales

Cornford¹,

Mason²,

Buchanan

et al. 2008

PHC

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Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.

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“…Desde que se comenzó a dispensar metadona en los años 60 4,5 hasta la actualidad, se han sucedido varios estudios y publicaciones que dan cuenta de su efectividad como tratamiento sustitutivo para la adicción a opioides. La evaluación de esta efectividad abarca diferentes áreas del funcionamiento de los pacientes, entre ellas: supresión del sín-drome de abstinencia a opiáceos (SAO), la reducción del ansia o deseo de consumo ("craving"), retención en el tratamiento, la reducción del uso de opiáceos ilícitos 6,7 , la reducción de las actividades delictivas 8 y de la mortalidad 9,10 . Por otro lado, la influencia ejercida en cuanto los riesgo de transmisión de VIH (Virus de Inmunodeficiencia Humana), es también importante 11,12,13 , hecho ligado a la reducción de la utilización de la vía endovenosa y el compartir material de inyección 7,14,15,16,17 .…”

Section: Introductionunclassified

“…Por otro lado, la influencia ejercida en cuanto los riesgo de transmisión de VIH (Virus de Inmunodeficiencia Humana), es también importante 11,12,13 , hecho ligado a la reducción de la utilización de la vía endovenosa y el compartir material de inyección 7,14,15,16,17 . La prescripción y dispensación bajo supervisión medica de la metadona, cuando va acompañada de intervenciones psico-sociales de cualquier índole, consigue mejores resultados que cuando no lo hace 6,7,18,19 . En la actualidad, la composición de los equipos terapéuticos de los TM en España es multidisciplinar y se corresponde con profesionales que ofrecen cobertura médica, social, psicológica y/o psiquiátri-ca 20 .…”

Section: Introductionunclassified

Percepción de usuarios de los Programas de Tratamiento con Metadona sobre la accesibilidad y atención recibida de los equipos terapéuticos

Cerdá

Martín-Ruiz²,

Oviedo‐Joekes

et al. 2006

Adicciones

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RESUMENFundamento: Se explora la atención y cobertura terapéutica prestada desde los Centros de atención al Tratamiento de las toxicomanías de dos ciudades españolas desde la perspectiva de sus usuarios de los Tratamientos con Metadona (TM). Se pretenden ofrecer claves de cómo orientar el TM para su mejora en la prevención de recaídas y abandonos prematuros, y facilitar la reinserción de sus pacientes.Métodos: Estudio exploratorio, cualitativo, que recoge información a través de una entrevista semi-estructurada a 30 usuarios de los TM en Barcelona y Granada Resultados: La atención prestada por los equipos terapéu-ticos queda articulada sobre 3 pilares: médico, psicológico y social. La centralidad de la figura de los médicos en los discursos de los pacientes, refleja el papel principal de la metadona y su prescripción. Casi el 60% ha visitado en los últimos 3 meses al profesional de medicina, reduciéndose esta cifra al 22% para el caso el caso de la psicología y un 6% con trabajo social. Los usuarios expresan la falta de una evaluación global e individualizada de la integración social, la escasez de recursos (vivienda, empleo y formación, necesidades básicas) adaptados a las necesidades particulares y la falta de implicación de las familias, donde el papel de psicólogos y trabajadores sociales podría ser mayor al actual.Conclusiones: A pesar de los resultados positivos obtenidos de los TM, su principal limitación es la falta de una intervención integral a las necesidades individuales de los pacientes. Fortalecer el papel de la intervención psicológica y social, se convierte en requisitos imprescindibles para avanzar en la rehabilitación y reinserción. ABSTRACTBackground: This study explores the type of care and the therapeutic treatment provided at drug treatment centres located in two Spanish cities, as perceived by methadone treatment (MT) users. It provides key aspects to improve the ability of MT programmes to prevent relapses and premature discharges from treatment, and to facilitate users' social reintegration.Methods: Exploratory qualitative study based on semistructured interviews among 30 MT programme users in the cities of Barcelona and Granada.Results: The care provided by therapeutic teams relies on 3 main intervention areas: medical, psychological and social care. The central role attributed to the physicians in users' discourses reflects the relevance assigned to the methadone and to its medical prescription. Almost 60% of users had visited their prescribing doctor at least once in the previous three months, 22% their psychologist, and only 6% their social worker. Users interviewed mentioned the absence of a comprehensive and individualized assessment of their social integration, the lack of resources adapted to their individual needs (housing, employment, training and basic needs), and the lack of family implication where they felt that psychologists and social workers could play a much more relevant role than at present.Conclusions: Despite the generally positive outcomes of the MT, its main limi...

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Fortnightly Review: Methadone maintenance treatment in opiate dependence: a review

Cited by 360 publications

References 73 publications

Positron Emission Tomography Molecular Imaging of Dopaminergic System in Drug Addiction

Positron Emission Tomography Molecular Imaging of Dopaminergic System in Drug Addiction

A survey of primary and specialised health care provision to prisons in England and Wales

Percepción de usuarios de los Programas de Tratamiento con Metadona sobre la accesibilidad y atención recibida de los equipos terapéuticos

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