Methadone complications amongst opioid‐dependent patients in Malaysia: A case series

George, Philip; Vicknasingam, Balasingam; Thurairajasingam, Sivakumar; Ramasamy, Parameswaran; Yusof, Haslina Mohd; Yasin, Mohd Azhar Bin Mohd; Shah, Zia U. Bahkt Sultan

doi:10.1111/dar.12456

Cited by 9 publications

(3 citation statements)

References 15 publications

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“…Since mitragynine is extracted from kratom leaves, it can be accessed easily and cheaper as compared to other drugs. Methadone replacement therapy is still subjected to overdose and fatalities due to a lack of ceiling effects at the level of respiratory depression and sedation, as seen in morphine overdose (110). The methadone dose varies between patients and it is very hard to identify the best dose to be given to patients.…”

Section: Discussionmentioning

confidence: 99%

Mitragynine Attenuates Morphine Withdrawal Effects in Rats—A Comparison With Methadone and Buprenorphine

et al. 2020

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Background: Opiate addiction is a major health problem in many countries. A crucial component of the medical treatment is the management of highly aversive opiate withdrawal signs, which may otherwise lead to resumption of drug taking. In a medication-assisted treatment (MAT), methadone and buprenorphine have been implemented as substitution drugs. Despite MAT effectiveness, there are still limitations and side effects of using methadone and buprenorphine. Thus, other alternative therapies with less side effects, overdosing, and co-morbidities are desired. One of the potential pharmacotherapies may involve kratom's major indole alkaloid, mitragynine, since kratom (Mitragyna speciosa Korth.) preparations have been reported to alleviate opiate withdrawal signs in self-treatment in Malaysian opiate addicts. Methods: Based on the morphine withdrawal model, rats were morphine treated with increasing doses from 10 to 50 mg/kg twice daily over a period of 6 days. The treatment was discontinued on day 7 in order to induce a spontaneous morphine abstinence. The withdrawal signs were measured daily after 24 h of the last morphine administration over a period of 28 abstinence days. In rats that developed withdrawal signs, a drug replacement treatment was given using mitragynine, methadone, or buprenorphine and the global withdrawal score was evaluated. Results: The morphine withdrawal model induced profound withdrawal signs for 16 days. Mitragynine (5-30 mg/kg; i.p.) was able to attenuate acute withdrawal signs in morphine dependent rats. On the other hand, smaller doses of methadone (0.5-2 mg/kg; i.p.) and buprenorphine (0.4-1.6 mg/kg; i.p.) were necessary to mitigate these effects. Conclusions: These data suggest that mitragynine may be a potential drug candidate for opiate withdrawal treatment.

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Section: Discussionmentioning

confidence: 99%

Mitragynine Attenuates Morphine Withdrawal Effects in Rats—A Comparison With Methadone and Buprenorphine

et al. 2020

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“…The patients undergoing MMT often have co-morbidities, where they are already on prescription drugs, therefore when added with methadone it might lead to unwanted drug-drug interactions, such as the development of “opioid withdrawal-like symptoms” in the case of efavirenz and zidovudine which are common treatments for HIV patients who are highly prevalent under the MMT program ( George et al, 2018 ). Patients with opioid dependence also tend to have higher rates of mood disorders and other illicit substance abuse, where a combination of these factors may lead to the possibility of central nervous system effects and worsening behavioral symptoms ( George et al, 2018 ). Other potential adverse effects of methadone include nephrotoxicity ( Atici et al, 2005 ; Lentine et al, 2015 ) and cardiotoxicity ( Kumar, 2010 ).…”

Section: Pharmacotherapy For Opioid Use Disorder and Methamphetamine ...mentioning

confidence: 99%

Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail

et al. 2022

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Globally, millions of people suffer from various substance use disorders (SUD), including mono-and polydrug use of opioids and methamphetamine. Brain regions such as the cingulate cortex, infralimbic cortex, dorsal striatum, nucleus accumbens, basolateral and central amygdala have been shown to play important roles in addiction-related behavioral changes. Clinical and pre-clinical studies have characterized these brain regions and their corresponding neurochemical changes in numerous phases of drug dependence such as acute drug use, intoxication, craving, withdrawal, and relapse. At present, many studies have reported the individual effects of opioids and methamphetamine. However, little is known about their combined effects. Co-use of these drugs produces effects greater than either drug alone, where one decreases the side effects of the other, and the combination produces a prolonged intoxication period or a more desirable intoxication effect. An increasing number of studies have associated polydrug abuse with poorer treatment outcomes, drug-related deaths, and more severe psychopathologies. To date, the pharmacological treatment efficacy for polydrug abuse is vague, and still at the experimental stage. This present review discusses the human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination. This narrative review also delineates the recent advances in the pharmacotherapy of mono- and poly drug-use of opioids and methamphetamine at clinical and preclinical stages.

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“…Furthermore, drug interactions are often a cause of mortality and morbidity, and patients on methadone commonly have medical and psychological co-morbidity or may abuse other illicit substances leading to adverse reactions. 11 The effect of heroin addiction and its treatment on oral health is not well studied, but previous studies have demonstrated a higher prevalence of caries and periodontal diseases among heroin users due to poor diet, hyposalivation, personal neglect, inadequate oral hygiene practice, and altered microbiome. 12,13,14,15,16 Furthermore, the provision of proper oral health care for heroin users might be complicated by the negative attitude towards dental care, the altered mental status, anxiety and fear, drug interaction and associated medical co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Oral healthcare management in heroin and methadone users

Abed

Hassona²

2020

BDJ Team

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Heroin addiction is associated with poor oral health. Oral and dental care in heroin addiction might be complicated by altered mental status, negative attitude towards oral health, dental anxiety and fear, drug interaction, and associated medical co-morbidity. We present the oral findings and discuss the dental, behavioural, and anaesthetic management considerations in a 46-year-old man who had dental anxiety and had been an intravenous heroin user for the past 23 years.

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Methadone complications amongst opioid‐dependent patients in Malaysia: A case series

Cited by 9 publications

References 15 publications

Mitragynine Attenuates Morphine Withdrawal Effects in Rats—A Comparison With Methadone and Buprenorphine

Mitragynine Attenuates Morphine Withdrawal Effects in Rats—A Comparison With Methadone and Buprenorphine

Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail

Oral healthcare management in heroin and methadone users

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