Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996–2006

Nosyk, Bohdan; Marsh, David C.; Sun, Huiying; Schechter, Martin T.; Anis, Aslam H.

doi:10.1016/j.jsat.2010.03.008

Cited by 97 publications

(89 citation statements)

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“…Nosyk et al . has also shown in British Columbia that the majority of patients do not discharge successfully from maintenance therapy 61, but a recent study in multiple sites suggests that the preponderance of shorter treatments may be greater in the United Kingdom than elsewhere 62. For example, a study in Germany found almost two‐thirds of patients retained on OST at 1 year 63, 64.…”

Section: Discussionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Section: Discussionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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“…A este respecto, se ha descrito que los tratamientos con metadona salvan dos vidas por cada fallecimiento anual (Whelan y Remski, 2012). La fase de instauración inicial es especialmente peligrosa, puesto que el riesgo de sobredosis mortal durante las primeras dos semanas de tratamiento es casi 7 veces mayor que aquella estimada para pacientes dependientes a la heroína que no reciben tratamiento y hasta 98 veces mayor que los pacientes con dosis de mantenimiento de metadona (Nosyk, Marsh, Sun, Schechter y Anis, 2010).…”

Section: Seguridad De Los Tmmunclassified

Efectividad a largo plazo de los tratamientos de mantenimiento con metadona en personas con adicción a derivados opiáceos

García

Bobes-Bascarán

2012

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There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the effectiveness of methadone as a long-term treatment for the addiction to opiates. Strengths include less illegal drug use, decreased criminal activity and better general functioning. Also physical and mental health seems to be more preserved and recovered. Since patients undergoing methadone treatment exhibit diminished likelihood of suffering from cardiovascular conditions, HIV, HCV, HBV and other infections, and lesser psychiatric comorbidity. This Editorial intends to define and guide the therapeutic statement to address the management of persons with opiate abuse or dependence. These proposals have been grounded in the main long-term studies, systematic analysis and meta-analytic approaches on the effectiveness of methadone. Thereby it is recommended, with the maximum level of evidence, methadone maintenance treatments in spite of its weaknesses (ie. Toxicity, cardiovascular risk, sedation problems and cognitive impairment), considering the clinical history, general health status, and willingness and preferences of the patient.Key words: methadone long-term treatment, methadone maintenance treatment, opiate addiction, effectiveness of methadone, doses and toxicity of methadone.Los estudios prospectivos de grandes series con distintas dosis de mantenimiento y marcadores distales estandarizados no existen, sin embargo actualmente existe evidencia acerca de la efectividad de la metadona como tratamiento a largo plazo de la adicción a opiáceos. Entre sus resultados se puede destacar un menor consumo de sustancias ilegales, menor implicación en actividades criminales y mejor funcionamiento social general. Por otra parte, la salud física y mental permanece más conservada y recuperada. Puesto que los pacientes en tratamiento con metadona presentan menos probabilidad de padecer problemas cardiovasculares, VIH, hepatitis C, hepatitis B y otros procesos infecciosos, así como una menor comorbilidad psiquiátrica. Este editorial pretende definir y guiar el posicionamiento terapéutico a la hora de abordar el manejo de personas con abuso o dependencia a opiáceos. Para fundamentar las pautas guía se han tenido en cuenta y revisado los principales estudios a largo plazo, análisis sistemáticos y aproximaciones meta-analíticas de la efectividad de la metadona. Por todo ello se recomiendan, con el máximo nivel de evidencia, los tratamientos de mantenimiento con metadona a pesar de las debilidades en cuanto a toxicidad y riesgo cardiovascular, y las dificultades de sedación y disminución del funcionamiento cognoscitivo, siempre teniendo en cuenta la historia clínica, el estado de salud general, y los deseos y preferencias del paciente.Palabras clave: tratamiento a largo plazo con metadona, tratamiento de mantenimiento con metadona, adicción a opiáceos, efectividad de la metadona, dosis y toxicidad de la metadona.Efectividad a largo plazo de los tratamientos de mantenim...

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“…[1,2] The conditions of access to methadone maintenance treatment (MMT) vary across countries, but are generally highly controlled because of methadone's pharmacodynamic properties. [3][4][5][6][7][8] In Europe (European Union-27, Norway and Croatia) in 2010, methadone was used by three quarters of patients on OMT while buprenorphine was prescribed to most of the remaining patients (other substances represented less than 5%). [9,10] In France however, methadone has historically been less accessible than buprenorphine.…”

Section: Introductionmentioning

confidence: 99%

New Methadone Formulation in France: Results from 5 Years of Utilization

et al. 2015

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-Background. In France, methadone has historically been less accessible than buprenorphine. In 2008, a dry formulation (capsule) was introduced into the market, aimed in particular to improve methadone accessibility. Objective. To describe the impact (prevalence of use, patient profiles and compliance with requirements) of the dry methadone formulation in France. Method. A retrospective cohort (from 2008 to 2012) was created from the data of the French General Health Insurance System which covers 80% of the French population. For each years, all subjects affiliated to this insurance system in southeast France (about 8.5 million inhabitants) with at least two reimbursements of methadone between 1 st January and 31 st December were selected. Results. In 2012, the proportion of capsule users was almost the same as that of syrup users (40.0% versus 43.1%; p < 0.001). The rise in the number of methadone users has followed the rise in capsule users. Over the study period, the proportion of patients using benzodiazepines or antidepressants was 6-9% (p < 0.001) higher for capsule users than for syrup users. On average over the study period, 18% of subjects had at least one concurrent issue of the two forms. Conclusion. The study has shown the rapid spread of the capsule formulation among methadone users. This may suggest that the capsule is well accepted by patients and the medical community. However, the monitoring of methadone-related deaths should continue because of the pharmacodynamic properties of methadone and the context of relaxed regulations concerning access to methadone maintenance treatement (MMT).Abbreviations: see end of article.

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Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996–2006

Cited by 97 publications

References 32 publications

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Efectividad a largo plazo de los tratamientos de mantenimiento con metadona en personas con adicción a derivados opiáceos

New Methadone Formulation in France: Results from 5 Years of Utilization

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