Pharmacotherapy in the Treatment of Addiction: Methadone

Kreek, Mary Jeanne; Borg, Lisa; Ducat, Elizabeth; Ray, Brenda

doi:10.1080/10550881003684798

Cited by 87 publications

(75 citation statements)

References 127 publications

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“…Over four decades of research indicates that agonist maintenance therapy (AMT) utilizing methadone (a full opioid agonist) and, more recently, buprenorphine (a partial opioid agonist) is the most effective treatment for opioid dependence (Kleber, 2008; Kreek et al, 2010; Mattick et al, 2008). Social, economic and regulatory barriers limit access to AMT and consequently detoxification followed by psychosocial counseling, with accompanying high relapse rates, is the most common approach to opioid dependence treatment (Mattick et al, 2009; Mayet et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

Brigham

Slesnick

Winhusen

et al. 2014

Drug and Alcohol Dependence

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Background Detoxification with psychosocial counseling remains a standard opioid-use disorder treatment practice but is associated with poor outcomes. This study tested the efficacy of a newly-developed psychosocial intervention, Community Reinforcement Approach and Family Training for Treatment Retention (CRAFT-T), relative to psychosocial treatment as usual (TAU), for improving treatment outcomes. Methods A randomized, 14-week trial with follow-up visits at 6 and 9 months post-randomization conducted at two substance use disorder (SUD) treatment programs. Opioid-dependent adults (i.e., identified patient - IP) enrolled in a residential buprenorphine-detoxification program and their identified concerned significant other (CSO) were randomized to CRAFT-T (n=28 dyads) or TAU (n=24 dyads). CRAFT-T consisted of 2 sessions with the IP and CSO together and 10 with the CSO alone, over 14 weeks. TAU for the CSOs was primarily educational and referral to self-help. All IPs received treatment as usually provided by the SUD program in which they were enrolled. The primary outcome was time to first IP drop from treatment lasting 30 days or more. Opioid and other drug use were key secondary outcomes. Results CRAFT-T resulted in a moderate but non-significant effect on treatment retention (p = 0.058, hazard ratio = 0.57). When the CSO was parental family, CRAFT-T had a large and significant effect on treatment retention (p < 0.01, hazard ratio = .040). CRAFT-T had a significant positive effect on IP opioid and other drug use (p<0.0001). Conclusion CRAFT-T is a promising treatment for opioid use disorder but replication is needed to confirm these results.

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Section: Introductionmentioning

confidence: 99%

A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

Brigham

Slesnick

Winhusen

et al. 2014

Drug and Alcohol Dependence

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“…Women also have poorer treatment participation and retention than men in mixed-gender treatment settings (23). A consensus exists that women have different needs and deficient gender-specific services lead to barriers to care (24). Treatment that focuses on problems more common to substance-abusing women is effective (25).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in opioid use and medical issues during buprenorphine/naloxone treatment

Barbosa‐Leiker

McPherson

Layton

et al. 2018

The American Journal of Drug and Alcohol Abuse

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Background: There are sex differences in buprenorphine/naloxone clinical trials for opioid use. Whereas women have fewer opioid-positive urine samples, relative to men, a significant decrease in opioid-positive samples was found during treatment for men, but not women. In order to inform sex-based approaches to improve treatment outcomes, research is needed to determine if opioid use, and predictors of opioid use, differs between men and women during treatment. Objectives: To test for sex differences in opioid use during a buprenorphine/naloxone clinical trial and determine if sex differences exist in the associations between addiction-related problem areas and opioid use over the course of the trial. Method: This secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003 examined sex differences (men=347, women=169) in opioid-positive samples in a randomized clinical trial comparing 7-day vs. 28-day buprenorphine/naloxone tapering strategies. Addiction-related problem areas were defined by Addiction Severity-Lite (ASI-L) domain composite scores. Results: Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial (B=.33, p=.01) and medical issues were positively related to submitting an opioid-positive sample during treatment for women (B=1.67, p=.01). No ASI-L domain composite score was associated with opioid-positive samples during treatment for men. Conclusion: Women were more likely than men to use opioids during the course of the buprenorphine/naloxone clinical trial, and medical issues predicted opioid use during treatment for women but not men. Complementary treatment for medical problems during opioid replacement therapy may benefit women.

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“…In recent years, its demonstrated clinical efficacy and cost-effectiveness have made methadone an increasingly prescribed opioid, particularly in treating moderate-to-severe pain (211,212). Methadone consists of a racemic mix of R-and S-methadone (213), though the Risomer is believed to account for its opioid effects (214). Methadone is also lipophilic, highly protein bound (85%), and known for its relatively long half-life (215) and often unpredictable pharmacokinetics (216).…”

Section: Methadonementioning

confidence: 99%

Transporter-Mediated Disposition of Opioids: Implications for Clinical Drug Interactions

et al. 2015

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Opioid-related deaths, abuse, and drug interactions are growing epidemic problems that have medical, social, and economic implications. Drug transporters play a major role in the disposition of many drugs, including opioids; hence they can modulate their pharmacokinetics, pharmacodynamics and their associated drug-drug interactions (DDIs). Our understanding of the interaction of transporters with many therapeutic agents is improving; however, investigating such interactions with opioids is progressing relatively slowly despite the alarming number of opioids-mediated DDIs that may be related to transporters. This review presents a comprehensive report of the current literature relating to opioids and their drug transporter interactions. Additionally, it highlights the emergence of transporters that are yet to be fully identified but may play prominent roles in the disposition of opioids, the growing interest in transporter genomics for opioids, and the potential implications of opioid-drug transporter interactions for cancer treatments. A better understanding of drug transporters interactions with opioids will provide greater insight into potential clinical DDIs and could help improve opioids safety and efficacy.

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Pharmacotherapy in the Treatment of Addiction: Methadone

Cited by 87 publications

References 127 publications

A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

Sex differences in opioid use and medical issues during buprenorphine/naloxone treatment

Transporter-Mediated Disposition of Opioids: Implications for Clinical Drug Interactions

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