Subjective and objective symptoms in relation to plasma methadone concentration in methadone patients

Abstract

Two rating scales, which were originally developed for measurements of objective and subjective signs of opiate withdrawal, were used to evaluate potential estimates (correlates) of methadone effects in relation to plasma methadone concentrations. Patients participating in our regular methadone maintenance treatment project were studied during 24 h after the intake of the daily methadone dose. Methadone concentrations in plasma were compared to the subjective (estimated by the patients) and objective (estimated by the investigator) signs of the drug effects before, and 2.5, 5, 9 and 24 h after intake of methadone. Some new items possibly related to rising methadone concentrations were added to the subjective scale. Results indicated that, for subjective ratings, the majority of the items investigated corresponded well with the plasma methadone concentrations. The most significant associations were found for the following items: low psychomotor speed, alertness, running nose, yawning and anxiety. For objective ratings, only the items rhinorrhea, piloerection and signs of anxiety were significantly associated with the methadone concentrations. These rating scales may, together with plasma methadone determinations, be of considerable value when making dose adjustments for methadone maintenance patients. Further work is, however, needed to establish concentration-effect relationships.

Yawning in Diseases

“…Detoxication after prolonged use in heavy users of coffee or of opiates is accompanied by the withdrawal syndrome of repetitive yawning over several days [43,44,45,46,47,48,49]. The clinical profile of a neonate with a mother who consumes opiates, legal (methadone, morphine) or not until the end of her pregnancy, can be impressive with respiratory irregularities and pauses interspersed with salvos of yawning [50, 51].…”

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

“…Methadone is transported in a single dose, reaching a maximum level six hours after use, which then falls continuously until 24 hours. On the other hand, nicotine is delivered in little quantities that reach the central nervous system rapidly and undergo rapid clearance in a period of 24 hours (Hiltunen et al, 1995). Moreover, oral methadone produces sedative effects, but nicotine acts as a stimulant; these antagonist actions may induce tobacco users to use tobacco as stimulant with the aim of counteracting the sedative properties from oral methadone by titrating nicotine levels as a response to increases in methadone doses and the day-to-day highest serum levels of methadone (Preston, 1996).…”

Drug misuse in older people: old problems and new challenges

“…Elderly methadone-dependent patients are more likely to be seen in geriatric settings (Miller 1991;Gurnack 2002), are less likely to request detoxification and tend to continue the dose of methadone that they received when they were younger (Hiltunen 1995;Gurnack 2002). Gurnack et al (2002) also reported that older patients on methadone maintenance tend to prefer higher doses.…”