Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use.

Abstract

OBJECTIVES. The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. METHODS. Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients. RESULTS. Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. CONCLUSIONS. This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed.

Prevalence of tobacco, cocaine and alcohol use amongst patients attending for methadone-maintenance therapy in a rural setting

“…Best et al (1998) reported alcohol prevalence rates between 20% and 50% in a group of individuals receiving methadone-maintenance treatment (Best et al, 1998). The prevalence of cocaine use found in the present study in methadonemaintained individuals was 11.11%, and this is notably lower than the prevalence reported in previous studies (Hartel et al, 1995;Magura et al, 1998;Grella et al, 1997), which indicated a prevalence of between 50% and 73%. A plausible explanation for this may be that adults living in mainly rural communities such as East Kent are expected to experience less use of Class A drugs than those living in urban areas.…”

“…Despite this, the prevalence of cocaine use in methadone-maintained individuals in this study is not as high as reported in other studies conducted amongst such individuals. Some have reported values from 51.67% (Hartel et al, 1995) to 73% (Magura et al, 1998). This may be due to the factor explained above, namely that adults living in mainly rural communities such as East Kent are expected to experience less use of Class A drugs than those living in urban areas.…”

“…Correspondingly, elevated rates of illicit cocaine use have been detected in heroin-dependent individuals receiving methadonemaintenance therapy during the continuation of treatment (Leri, Stewart, Tremblay, & Bruneau, 2004). A study by Hartel et al (1995) found a prevalence of cocaine use of 51.7% amongst patients receiving methadone-maintenance treatment (Hartel et al, 1995). A survey by Magura, Kang, Nwakeze and Demsky (1998) found that 73% of 1,038 patients receiving methadone therapy tested positive for cocaine on urinalysis (Magura, Kang, Nwakeze, & Demsky, 1998).…”

Conditioned rewarding effects of morphine and methadone in mice pre-exposed to cocaine

“…The effectiveness of methadone is limited, however, in individuals who are using cocaine, where it results in higher rates of heroin use and treatment dropout [12,19,21,37]. Considering that concurrent use of cocaine is widespread in methadone treatment programs, seen in almost 50% of patients [5,12,17,25], the impact of cocaine on the effectiveness of methadone is of central importance.…”

“…Considering that concurrent use of cocaine is widespread in methadone treatment programs, seen in almost 50% of patients [5,12,17,25], the impact of cocaine on the effectiveness of methadone is of central importance. Similarly, a negative effect of concurrent use of cocaine has also been noted in individuals treated with buprenorphine [21,37].…”