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1
Stevenson, Tracey-Lee. "Methadone maintenance, from a woman's perspective". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ55933.pdf.
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Doverty, Mark. "Acute pain management in methadone maintenance treatment". Title page, abstract and table of contents only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phd743.pdf.
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"December 2001" Includes bibliography. In the light of a general concensus that in the treatment of pain, patients with a prior history of substance abuse (particulary opioid dependence) appear to be at increased risk for pain mismanagement problems, this thesis aims to produce data that will eventually help in the formulation of prescribing guidelines, improved policies, and help direct optimal acute pain management for methadone maintenance patients.
3
Ballantyne, Sue. "Methadone maintenance, myth or miracle? : a review of the Queensland Methadone Program 1995-1999 /". [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16708.pdf.
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Lee, Yan-tsang Samuel. "A study of the relationship between the perception of entry to treatment by young drug abusers attending the government methadone treatment program and program attendance /". Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2013390X.
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Wong, Yiu-kwong. "The effectiveness of the methadone treatment programme and its implications on the anti-drug policy of the HKSAR Government". Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22032368.
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Wong, Chung Shiu-wah Wendy. "The development of the methadone treatment programme in Hong Kong". Click to view the E-thesis via HKUTO, 1988. http://sunzi.lib.hku.hk/hkuto/record/B31975641.
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Eastgate, Katherine. "Methadone maintenance treatment : what are the implications for mothers?" Thesis, University of Hertfordshire, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421276.
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Wang, David. "Sleep disordered breathing in stable methadone maintenance treatment patients /". Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002992.
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Wong, Chung Shiu-wah Wendy, i 黃鍾兆華. "The development of the methadone treatment programme in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1988. http://hub.hku.hk/bib/B31975641.
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Petitjean, Sylvie. "Methadone maintenance treatment in general practice or in specialized centers". Lengerich Berlin Bremen Miami, Fla. Riga Viernheim Wien Zagreb Pabst Science Publ, 2005. http://d-nb.info/1001501985/04.
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Duronville, John V. "God, drugs, and hope lived religious experiences in a methadone maintenance clinic /". Diss., Connect to the thesis, 2007. http://hdl.handle.net/10066/994.
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Lai, Wing-kai Winky. "A study of factors affecting the effectiveness of the methadone treatment program". Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22331323.
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Pearson, Courtney. "Personal Perceptions and Experiences of Methadone Maintenance Treatment: A Qualitative Descriptive Research Study". Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/33415.
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Over the past ten years, there has been a consistent increase in opioid use, which has resulted in an increase in enrolment in methadone maintenance therapy [MMT]. With retention in MMT being a key factor, in order to understand the process of retention, it is important to gain an understanding of individual perceptions and experiences. No research in Ottawa, Ontario has addressed the perspective of MMT from people enrolled in MMT; therefore, nursing based research was undertaken. The objective was to understand the process and experiences associated with MMT from the perspective of persons who are enrolled in treatment. Twelve participants were engaged in semi-structured interviews. These participants described that, although MMT can positively affect the people who use such a treatment option, it continues to have a negative impact that repeatedly affects MMT initiation and delivery. The theoretical framework of Hardt and Negri’s “Triple Imperative of Empire” was used to analyze the research participants’ interviews within the current MMT program, to help develop a more inclusive healthcare service that addressed the current barriers hindering access and retention in treatment. The integration of this framework can help engage persons in treatment, tailor treatment to patient specific needs, and as a result increase access and retention in MMT programs.
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Mims, Carla A. "An exploratory study of client preference towards methadone maintenance as compared to methadone detoxification in an outpatient treatment facility". DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1996. http://digitalcommons.auctr.edu/dissertations/3490.
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The overall objective of this study was to determine if there was a relationship among male and female methadone maintenance client preference in an outpatient treatment facility. To obtain this objective, the following areas were addressed by the researcher: (a) characteristics of the clients in the outpatient facility, (b) issues relating to drug and alcohol use, (c) issues related to current treatment, (d) general knowledge questions. An exploratory research design was used in the study. A self administered questionnaire was given to the methadone maintenance clients in an outpatient clinic located in Atlanta, Georgia. The results of the study indicated that there is no significant difference in client preference towards treatment between the methadone maintenance and methadone detoxification client(s) in an outpatient treatment setting. The estimated value is .1415, with DF 3.792, and a 2-tail probability of .059.
15
Liu, Enwu. "Factors influencing client retention in methadone maintenance treatment clinics in China". Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1580792601&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Fresquez, Teresa Lyn. "Effect of Therapeutic Alliance of Clients on Methadone Maintenance Treatment Outcomes". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3297.
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Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical framework of this study is based on therapeutic alliance, which guided an examination on whether therapeutic alliance (as measured by the Session Rating Scale) influenced MMT retention and compliance (drug screens and session attendance). Archival data from 264 clients receiving MMT for opioid dependence were reviewed from a nonprofit community-based agency in Arizona. Logistic regression results revealed that TA did not significantly affect retention or compliance. However, issues were noted such as how the SRS was administered, a lack of understanding by clients regarding scoring the SRS, and unique social desirability demands when clients are in MMT. The finding that TA alone did not significantly affect retention and compliance does not decrease the need to find effective means to improve MMT outcomes. Rather, the findings suggest a critical need to identify and utilize measures more appropriate for clients receiving MMT. In doing so, positive social change may be achieved by assisting clinical staff in developing a strong therapeutic alliance with MMT clients as they focus on problem solving as a joint venture when challenges in the recovery process arise.
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Pace, Christine A. "Substance use outcomes among pregnant and postpartum women in methadone maintenance treatment". Thesis, Boston University, 2012. https://hdl.handle.net/2144/12552.
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Thesis (M.S.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: Methadone maintenance treatment (MMT) is widely used to treat opioid dependence during pregnancy. Though data suggest pregnant women are more likely to engage in MMT compared to non-pregnant women, few studies have examined the effect of pregnancy on abstinence from illicit substances. In addition, there are scant data on postpartum substance use outcomes despite the importance of the postpartum period in determining whether a woman continues in recovery long-term. Methods: Retrospective study of medical records from pregnant and non-pregnant women who emolled in an MMT program over a five year period. Multivariable generalized estimating equations (GEE) logistic regression was used to examine the effect of pregnancy status (pregnant, postpartum or non-pregnant) on the odds of giving an opiate negative urine drug test, and on the odds of giving a urine that was negative not only for opiates, but also for cocaine and benzodiazepines. Results: Urine drug tests from pregnant and postpartum women had almost three times the odds of being opiate-negative urine compared to those from non-pregnant women (AOR 2.90, 95% CI 1.94, 4.33 for pregnant vs. non-pregnant; AOR 2.78, 95% CI 1.77, 4.38 for postpartum vs. non-pregnant). Drug tests from women who were in a residential program on emollment were more likely to be opiate-negative. Results were similar for urine drug tests that were negative for opiates, cocaine and benzodiazepines. Conclusions: Pregnant women with opioid dependence reduce their use substantially in the context of a comprehensive, multidisciplinary program including MMT, and women who remain in MMT postpartum continue to do well. However, the programming needs of non-pregnant women require more attention. In particular, further research should identify whether enhanced access to residential programs or other treatment modalities could help improve this group's engagementwith recovery.
18
Grönbladh, Leif. "A National Swedish Methadone Program 1966-1989". Doctoral thesis, Uppsala University, Department of Neuroscience, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4001.
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Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction.
In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala.
The aim of this thesis was to study the outcome of methadone treatment along various lines:
• An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age.
• Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program.
• Retention in treatment.
Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting.
Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission.
Conclusion: The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.
19
Lin, Chunqing. "Factors associated with successful implementation of the methadone maintenance therapy (MMT) programs in China". Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=1723178181&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Lai, Wing-kai Winky, i 黎榮佳. "A study of factors affecting the effectiveness of the methadone treatment program". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B4389401X.
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Nehring, Sandra Ellen. "An exploratory study of heroin addicts' perceptions of methadone treatment". CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1237.
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Methadone treatment continues to be the most widely used treatment modality for heroin addiction despite continued controversy. The efficacy of methadone treatment has been determined primarily by statistical research of program outcomes. This study explored heroin addicts' perceptions of methadone treatment.
22
Davie-Gray, Alison. "The Early Development and Family Environments of Children Born to Mothers Engaged in Methadone Maintenance During Pregnancy". Thesis, University of Canterbury. Psychology, 2011. http://hdl.handle.net/10092/5508.
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Introduction. There is clear evidence that children raised in families affected by parental drug use are at high risk for a wide range of adverse outcomes, including; early cognitive and language delay (van Baar & de Graaff, 1994); poor school attendance and educational under-achievement (Hogan & Higgins, 2001; Steinhausen, Blattmann, & Pfund, 2007); substance abuse and psychological problems (Keller, Catalano, Haggerty, & Fleming, 2002; Kilpatrick, Acierno, Saunders, Resnick, Best, & Schnurr, 2000; Kolar, 1994; Lagasse, Hammond, Liu, Lester, Shankaran, Bada et al., 2006; Merikangas, Dierker, & Szatmari, 1998; Moss, Vanyukov, Majumder, Kirisci, & Tarter, 1995; Nunes, Weissman, Goldstein, McAvay, Beckford, Seracini et al., 2000; Nunes, Weissman, Goldstein, McAvay, Seracini, Verdeli et al., 1998; Stanger, Higgins, Bickel, Elk, Grabowski, Schmitz et al., 1999). Careful examination of the impact of parental drug use on children and the developmental mechanisms associated with risk and resilience is central to the establishment of appropriate intervention. Children born to mothers who are drug dependent and enrolled in methadone maintenance treatment during pregnancy face the “double jeopardy” of prenatal drug exposure and post-natal environmental disadvantage (Zuckerman & Brown, 1993). This research aimed to identify early developmental difficulties or differences in communicative and cognitive development, and in particular the joint attention skills, of young children born to mothers engaged in methadone maintenance treatment. Of particular interest was the way in which pre- and postnatal factors combined to influence developmental outcome at age 2 years. This prospective, longitudinal study offered the opportunity to indentify early indicators of developmental differences in this group and thus, contribute to a better understanding of the long-term mechanisms of risk.
Research Methods. Sixty children born to mothers engaged in methadone maintenance treatment and 60 randomly-selected, non-exposed comparison children were followed prospectively from birth to age 2 years. During the third trimester of pregnancy, mothers completed a comprehensive maternal interview. At 18 months, children were visited at home and evaluations of the social background, family and childrearing context were completed. At age 2 years, all children underwent a developmental assessment that included the Early Social Communication Scales (ESCS) (Mundy, Hogan, & Doehring, 1996). The ESCS consists of a semi-structured series of activities, which assess the joint attention abilities, social skills and interactive behaviour of infants aged 8 to 30 months. The focus of this study was on children’s use of two types of communicative behaviour – requesting and affect-sharing communications. Alongside the ESCS, the Mental Development Index (MDI) and language items from the Bayley Scales of Infant Development (BSID-II) (Bayley, 1993) and the Communication and Symbolic Behaviour Scales– Developmental Profile (CSBS-DP) (Wetherby & Prizant, 1998), were used to assess concurrent cognitive and language skills.
Results. The results of this study indicated that children born to mothers engaged in methadone maintenance treatment were typically growing up in single-parent families (p=<.0001) and in welfare-dependent households (p=<.0001). Methadone-exposed children were also more likely to be living in out-of-home care placements at age 18months than comparison group children (p=<.0001). Their caregivers were less likely to be accepting of (p=<.01) and responsive to their needs (p=.008) compared to parents of comparison children. At home, methadone-exposed children had fewer learning opportunities (p=<.0001) and were more likely to live in houses where the television was on for longer, compared to non-exposed children (p=<.001). Caregivers of methadone-exposed toddlers reported more depression (p=<.0001), more illicit substance use (p=<.0001) and more family stress (p=.004) than comparison caregivers. They were also more often victims of psychological aggression (p=.002) and violence from others (p=<.0001), but they also reported that they were more likely to use psychological aggression (p=<.001) and physical punishment (p=<.03) in managing their children’s behaviour than comparison caregivers.
The developmental assessment at age 2 years suggested that methadone-exposed children were significantly more likely to engage in communicative behaviour, which expressed a request, than non-exposed, comparison children (p=.03). On the other hand, analysis suggested that whilst methadone-exposed children were less likely than comparison children to engage in communication, which had the goal of affect sharing, this difference did not reach significance (p=.27). Previous research links greater use of requesting behaviours with later behaviour problems (Sheinkopf, Mundy, Claussen, & Willoughby, 2004). The MDI, BSID language measure and CSBS results further indicated significant delay in both cognitive (p =<.0001) and language development (p =<.0001) in the methadone-exposed group, compared to the comparison group. Between group differences were attenuated by control for confounding social background and prenatal factors, including maternal education, gestational age, other drug exposures during pregnancy and gender, but significant differences remained. Further analysis suggested that parenting practices and family environment factors were important intervening influences on the relationship between being born to a mother engaged in methadone maintenance treatment and poorer outcomes. More specifically, the association between methadone-exposure and differences in joint attention behaviours, were explained by caregiver use of psychological aggression (p=.01), caregiver disruption (p=.07) and caregiver stress (p=.01). On the other hand, poorer cognitive and language outcomes were explained by family contextual factors, including a less child-centered home environment (p=.008), caregiver disruption (p=.001), increased use of background TV (p=.02) and fewer stimulating activities (p=.06)
Discussion. The family circumstances of children born to mothers engaged in methadone maintenance treatment during pregnancy, when compared with a group of randomly-selected comparison children, showed pervasive differences and multiple disadvantage. Findings suggest that these differences in family disruption, family functioning and parenting practices explain the negative outcomes of methadone-exposed children in early cognitive and communication skills at age 2 years. These results raise concerns for the later functioning of methadone-exposed children and emphasise the key importance of early intervention for children and families affected by parental drug use.
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Dell, Erin. "Nurses' attitudes and experiences working with women receiving methadone maintenance therapy in the postnatal period". Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/50283.
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Abstract
When working with women and infants on methadone maintenance treatment (MMT), obstetrical nurses may encounter an array of challenges concerning preparation, assessment, workload, and fostering a positive relationship with patient families. Obstetrical nurses also have distinct ways in which they work with each woman to build rapport and provide quality, safe, and effective care. Many research studies have focused on how nurses’ attitudes toward addiction and substances use impacts the quality of care provided, but few studies have explored the experiences of obstetrical nurses caring for women on MMT. This study addresses this knowledge gap, providing insight into how obstetrical nurses provide health care to women and infants on MMT.
The findings indicated that most participants drew on personal ideals about mothering, a collaborative team approach, and a non-judgmental attitude to meet the needs of the families on MMT. That said, most participants also recognized their lack of education surrounding MMT and how this impacted the care they provided. Many participants also reported difficulty establishing a positive relationship due to structural constraints - such as workload and staffing - which affected the time required to provide effective bedside care. Finally, this study highlights opportunities to learn how to increase understanding of nurses’ experiences working with women on MMT.Applied Science, Faculty of
Nursing, School of
Graduate
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Zador, Deborah Public Health & Community Medicine Faculty of Medicine UNSW. "Studies in opioid drug related death". Awarded by:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/44765.
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Opioid drug related death is the topic of this thesis. Each of the published works submitted in this volume has investigated an aspect of opioid drug related death. The publications have been grouped into three sub-themes: i. Characteristics of opioid drug related deaths ii. Methadone-related deaths in and out of treatment iii. Improving the quality of treatment for opioid drug dependence: a focus on injectable opioid treatment The introduction and background (Chapter1) will briefly review-the-relevant literature on opioid drug death predating my own contribution to the field. The next chapter of the thesis, 'Publications' (Chapter 2), will comprise the body of published work being submitted for the degree of Doctor of Medicine. Each article is accompanied by text on the preceding page outlining my individual contribution to that research study. The thesis will conclude with a discussion of the published works (Discussion, Chapter 3) which summarises the chief findings and reflects on the international significance and impact of the work. Finally, the Conclusion (Chapter 4) will submit suggestions for areas of future research into opioid drug related death.
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Sheerin, Ian G., i n/a. "Consequences of drug use and benefits of methadone maintenance therapy for Maori and non-Maori injecting drug users". University of Otago. Christchurch School of Medicine & Health Sciences, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070502.142602.
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The consequences of drug use and benefits of methadone maintenance therapy (MMT) were investigated in a random sample of Maori and non- Maori injecting drug users in Christchurch, Aotearoa New Zealand. Eighty- five injecting drug users (IDUs) who had been on MMT for a mean time of 57 months were interviewed and followed up over an average 18 month period.
Markov models were used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. The savings in life from reductions in drug overdoses were used as the main outcome measure in cost-effectiveness analysis. Cost-utility and cost-benefit analysis were also used to provide additional information on the costs and outcomes of treatment. Comparisons were made between: (a) MMT alone; (b) MMT provided with conventional combination therapy for hepatitis C virus (HCV); and (c) MMT provided with anti-viral therapy with pegylated interferon.
The monetary costs of drug use and benefits of MMT were similar for Maori and non-Maori. However, Markov modelling indicated that MMT is associated with greater savings in life for Maori than for non-Maori. Further, Maori IDUs identified the main personal costs of drug use as being loss of their children and loss of marriage or partners.
Large reductions in use of opioids and benzodiazipines were reported at interview, compared with before starting MMT. The participants also reported large reductions in crime and stabilisation of their lifestyles. Improvements in the general health of IDUs om MMT were reported. However, 89% were positive for HCV infection, which was identified as the major physical health problem affecting IDUs in New Zealand. Few IDUs had received anti-viral therapy for HCV infections, despite having stabilised on MMT. This study investigated the benefits of providing anti-viral therapy for HCV to all patients meeting treatment criteria.
The cost-effectiveness of MMT alone was estimated at $25,397 per life year saved (LYS) for non- Maori men and $25,035 for non-Maori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing anti-viral therapy for HCV to all eligible patients were to save extra years of life, as well as to involve additional costs. The net effect was that anti-viral therapy could be provided, at a similar level of cost-effectiveness, to all patients who meet HCV treatment criteria. Cost-effectiveness could be improved if IDUs could be stabilised on MMT five years earlier at an average age of 26 instead of the current age of 31 years. The cost-effectiveness of treatment with pegylated interferon was similar to that for conventional combination therapy because there were incremental savings in life as well as increased treatment costs.
Costs per LYS were estimated to be lower for Maori than for non-Maori, reflecting ethnic differences in mortality. Sensitivity analysis revealed that provision of MMT with anti-viral treatment remained cost-effective under varying assumptions of mortality, disease progression and compliance with treatment.
the main problems that were not improved during MMT were continuing use of tobacco and cannabis, low participation in paid employment, only three participants had received specific treatment for their HCV infections.
Cost-benefit analysis using a conservative approach showed a ratio of the benefits to the costs of MMT of 8:1. Benefits were demonstrated in terms of large reductions in crime. Benefit to cost ratios were similar for the different policy examined, as well as for both Maori and non-Maori IDUs.
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Gibson, Amy Elizabeth National Drug & Alcohol Research Centre Faculty of Medicine UNSW. "Mortality among the recipients of methadone, buprenorphine and naltrexone maintenance for the treatment of opioid dependence: the levels, predictors and causes of mortality". Awarded By:University of New South Wales. National Drug & Alcohol Research Centre, 2009. http://handle.unsw.edu.au/1959.4/44508.
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Opioid dependence is a complex and persistent disorder with a high mortality rate and severe impact on health and social situation. It is associated with much harm, including the transmission of blood-borne bacterial and viral infections, self-harm, traumatic injury and drug overdose. All of these harms carry a risk of death, and accordingly, mortality rates in opioid-dependent people are many times higher than those in the general population of the same age and sex. One of the more commonly used strategies for reducing the risks of opioid dependence is the provision of maintenance treatment. In Australia, available maintenance treatments include methadone, buprenorphine, oral naltrexone, and the unregistered sustained-release formulation of naltrexone, naltrexone implants. This thesis reports on a range of data collections and study designs to investigate the levels, predictors and causes of mortality in opioid-dependent persons entering methadone, buprenorphine and naltrexone maintenance treatment in Australia. The studies used data linkage to examine mortality rates and causes of death in a longitudinal cohort of the early entrants to the NSW methadone program, examined the predictors of mortality (particularly the impact of methadone and buprenorphine treatment) using survival analysis in a longitudinal cohort study, compared national mortality rates between methadone, buprenorphine and naltrexone maintenance treatments in a cross-sectional analytic study, and used a small case series of coronial cases to examine whether death from opioid overdose was possible in a recipient of a naltrexone implant. This thesis demonstrates that mortality rates as a whole and from particular causes of death are many times higher in Australian opioid-dependent subjects than the general population, exposure to methadone or buprenorphine maintenance treatment significantly reduced mortality in a sample of opioid-dependent subjects, naltrexone treatment appears to have higher mortality than both methadone and buprenorphine maintenance treatments, and fatal opioid overdose while in receipt of sustained-release naltrexone treatment is possible. These results support longer retention in and repeated access to methadone and buprenorphine maintenance treatments in order to reduce mortality in opioid-dependent people, and greater regulation of the access to and more rigorous monitoring of the mortality associated with oral and sustained-release naltrexone maintenance treatments.
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Lean, Rachel Emma. "The Mental Health Outcomes of Children Born to Methadone Dependent Mothers : The Role of Out-of-Home Care at Age 4.5-Years". Thesis, University of Canterbury. Psychology, 2012. http://hdl.handle.net/10092/6865.
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Children born to methadone maintained mothers are at high risk of adverse socio-emotional and behavioural outcomes. However, existing studies inadequately report the extent of maternal methadone and other drug use, focus on a narrow range of outcomes, and have given little consideration to the possible impact of child protection and placement experiences. As part of a prospective longitudinal study, mothers of 53 methadone-exposed (ME) children and 54 non-exposed comparison children were interviewed at four time-points from term to the child turning 4.5-years. Detailed information about infant clinical, maternal and family background characteristics was recorded. The nature of all child out-of-home placements was reported at regular intervals using life history calendar methods. At 4.5 years, all caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and were interviewed using the Developmental and Well-Being Assessment (DAWBA) to examine the extent of child socio-emotional and behavioural adjustment problems as well as risk for a range of clinical disorders.
By age 4.5 years, ME children were rated by their caregivers as having higher levels of emotional (p = .01), peer-relationship (p = .01), hyperactivity/inattention (p = .01), conduct (p = .01) and total problems (p = .01) than comparison children on the SDQ. Between-groups differences persisted for conduct problems (p = .003) and total difficulties (p = .006) even after controlling for a range of covariates associated with maternal methadone maintenance therapy, including single motherhood, maternal educational achievement, family socioeconomic status (SES), and other drug use in pregnancy. On the DAWBA, children in the ME group were also significantly more at risk than comparison children for externalising disorders spanning ADHD (p = .02), hyperkinesis (p =.01), oppositional defiant disorder (p < .001), and conduct disorder (p = .007). Examination of all study children‟s family situation at 3-monthly intervals over the first 4.5-years revealed that 43% of children in the ME group had experienced at least one foster care placement (range: 1 – 7). In contrast, no comparison children had any placement experience (p < .01). Within the methadone group, maternal risk factors that predicted the likelihood of child placement included maternal methadone dose in pregnancy (p <.01), SES (p = .03), maternal depression (p <.01) and the extent of tobacco (p = .01) and illicit substance use while pregnant (p = .05). ME children exposed to placement showed some increased risk for internalising disorders such as separation anxiety disorder (p = .35) and specific phobia disorder (p = .35), whereas ME children remaining in their biological mothers‟ care tended to have an increased risk for externalising disorders such as ADHD, hyperkinesis and oppositional defiant disorder, although these differences did not reach statistical significance (ps < .05). Child placement did not appear to be independently contributing to the later mental health risks for ME children, at least to age 4.5-years. Rather, a very similar set of maternal psychosocial risk factors were associated with both out-of-home placement and child adjustment problems, thus highlighting the importance of socio-environmental adversity leading to both child removal from parental care and externalising behaviour problems. Further longer-term follow-up of ME children will be important to fully understand the emerging relationships between out-of-home care and the mental health outcomes of ME children.
These study findings have important clinical and public health implications. First, the increased risk for socio-emotional and behavioural adjustment problems and disorder as observed among the ME group suggests that appropriate clinical support is needed to address the problems experienced by these children, with the preschool years being a timely opportunity for early targeted interventions. Second, given that high risk ME children are also a population likely to encounter considerable early environmental instability, public healthcare protocols should be introduced to meet the specific developmental needs of young ME children as they transition through and adjust to the placement process.
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Komalasari, Rita. "Key perspectives on Opioid Substitution Treatment (OST) programmes, using Methadone Maintenance Treatment (MMT) programmes in Indonesian prisons as a case study". Thesis, University of Stirling, 2018. http://hdl.handle.net/1893/28543.
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Background Heroin dependence is associated with increased risk of the transmission of blood-borne viral (BBV) infections such as HIV, as a result of unsafe injecting practices. Opioid Substitution Treatment (OST) Programmes including Methadone Maintenance Treatment (MMT) programmes are a recommended way of addressing heroin dependence with the dual aims of reducing both heroin use and associated harms. However, OST programmes, particularly in prison settings, are often unavailable, in spite of large numbers of prisoners with heroin dependence and the high risk of HIV transmission in the prison setting. Little is currently known about the delivery of OST programmes within prison settings. A systematic literature review conducted within this study revealed that there are only a small number of studies from middle and lower-income countries and the perspectives of the range of stakeholders are often underrepresented. Aim and setting of this study This aim of this study was to understand the role of Methadone Maintenance Treatment (MMT) programmes within the context of HIV prevention programmes and to identify barriers and facilitators that influence the implementation, routine delivery and sustainability of methadone programmes in Indonesian prisons. Study design Three prison settings were selected as part of a qualitative case study. These comprised: a narcotics prison that provided methadone, a general prison that provided methadone, and a general prison, where there was no methadone programme. This allowed the exploration of multiple perspectives of prisoners and the diverse range of staff involved in the implementation of programmes. Interview and observational data were supplemented by data from medical case notes. Qualitative data underwent thematic analysis, with the help of framework analysis for data management. Principal findings This study found that there were many misconceptions about methadone programmes. HIV infection was not recognised as a problem and prison staff, healthcare staff and prisoners alike lacked understanding of the roles of methadone programmes. Prisoners participating in programmes were often stigmatised, while many prisoners believed methadone withdrawal was dangerous and could lead to death. These factors all contributed to low level participation, observed in both prisons with methadone programmes. Lack of confidentiality and associated stigmatisation as well as inappropriate assessment criteria also contributed to this, as did a lack of support systems. A reduction in international funding and a shift in national drug policy priorities away from the provision of methadone to drug-free Therapeutic Community (TC) programmes, together with a failure to embed methadone programmes within the daily prison routine currently pose challenges to effective implementation, delivery and programme sustainability. Conclusion Educating policy makers and practitioners could improve understanding of the roles of methadone programmes and increase support for programme delivery within prisons. It is therefore recommended that Indonesian government and prison policy focuses on ensuring effective delivery and sustainability of methadone programmes for people with heroin dependence in the prison setting.
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Evans, Jessica Smith. "Assessing and Comparing Attitudes Toward Addiction and Methadone Treatment". Ohio University / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1155845971.
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Broers, Kayser Barbara. "HIV and hepatitis B and C in a cohort of methadone maintenance clients in Geneva, 1988-1995". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ50728.pdf.
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Monwell, Bodil. "De sökte substitutionsbehandling-vad skiljde dem åt? : Jämförelse i bakgrundsfaktorer mellan opiat- och opioidberoende utifrån ASI-intervjuer". Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för beteendevetenskap och socialt arbete, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-19104.
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Through changes in the code of statutes, SOSFS 2009:27 (M), opioid addicts are excluded since March 1 2010 from possibilities to be accepted for substitution treatment. Opiate addicts are solitary admitted for substitution treatment from that date. Opioid addicts are excluded admission for treatment regardless of the fact that they fulfil the ICD-10 diagnosis F.11.2, i.e. opioid/opiate addictive criteria. The alteration in the statutes was carried out in reference to the fact that evidence for this kind of treatment intended for opioid addicts was missing. Both groups i.e. opiate – and opioid addicts, are nevertheless experienced in clinical work , to have extensive problems with addiction, health, social situation along with the risk of premature death. The purpose with this study is to identify what differences and/or similarities there are in background varieties and the severity of the problems between the groups. This is conducted with the use of a population (n=127) with comparable background material, e.g. collected Addictions Severe Index- interviews, scientifically survey and compare background factors and the severity of the problems. The main discovery in this study is that one can demonstrate great similarities between the groups regarding background as well as the severity of the problems. It is therefore of great interest, on a individual as well as a social oriented level, that pursued studies regarding diagnostic safety and on processes in substitution program are needed to generate further knowledge as a foundation for development of future care and changes in the code of statutes.
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Pritham, Ursula A. "Pharmacologic Treatment of Opiod Dependency in Pregnancy: Methadone Versus Buprenorphine and Subsequent Neonatal Abstinence Syndrome". Fogler Library, University of Maine, 2009. http://www.library.umaine.edu/theses/pdf/PrithamUA2009.pdf.
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Aronowitz, Shoshana. "Screaming Behind a Door: The Experiences of Individuals Incarcerated Without Opioid Maintenance Treatment". ScholarWorks @ UVM, 2015. http://scholarworks.uvm.edu/graddis/385.
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Background & Purpose: Opioid maintenance therapy (OMT) is an effective method of treating opioid addiction. Of incarcerated individuals in the U.S., 50-85% have a history of substance abuse, and >80% of inmates with opioid addiction history do not receive treatment. The purpose of this study was to explore individuals' experiences after being tapered from OMT upon incarceration. Methods: Interpretative phenomenological analysis (IPA) was employed using in-depth interviewing of 10 participants. Results: Analysis identified six themes that captured the essence of the participants' experiences. Implications & Conclusion: Losing OMT upon incarceration was described as an extremely stressful experience for many individuals, and may create issues for both inmates and facility staff. Further research is needed to discover ways in which to improve addiction treatment in prison.
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Elkader, Alexander. "Influencing Factors on Methadone Pharmacology: Impact on Satisfaction with Methadone Maintenance Treatment". Thesis, 2009. http://hdl.handle.net/1807/17756.
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The methadone maintenance treatment population suffers from high rates of comorbid psychiatric and substance use disorders. Despite a more than 40-year treatment history, not all patients are satisfied with methadone treatment and more than half of the patients complain of significant inter-dose withdrawal at least some of the time. The objectives of this research were to investigate the pharmacological response to methadone under the influence of comorbid major depressive disorder and smoking; and to identify factors
other than physical withdrawal symptoms that can differentiate patients based on their
complaints of dissatisfaction with treatment. In Study 1, seven depressed methadone maintenance patients experienced more opioid withdrawal symptomatology over a 24-hour methadone-dosing interval than 10 nondepressed methadone patients. Depression
severity was significantly correlated with trough opioid withdrawal severity. This
suggests that depression or depressive symptoms are related to reported opioid
withdrawal. In Study 2, many factors other than physical opioid withdrawal symptoms
were able to differentiate patients who were satisfied with treatment (holders, n=25),
partially satisfied with treatment (partial holders, n=35), and not satisfied with treatment(nonholders, n=30). Results suggested that these patient satisfaction groups cluster differently depending on physical opioid withdrawal, mood, psychological distress, and personality. Nonholders experienced more physical withdrawal symptoms, craving for
opioids, and negative drug effects. Holders had less psychological distress and
experienced less negative mood states than the other groups. Partial holders had less
agreeable personalities compared to patients in the other groups. In Study 3, opioid and
nicotine withdrawal symptoms and effects were measured in 40 methadone-maintained
patients who were current smokers during trough and peak methadone effects, both pre and post-nicotine administration. Cigarette smoking enhanced opioid withdrawal suppression during the peak methadone condition, methadone attenuated nicotine
withdrawal, and methadone and nicotine shared many of the same main effects,
suggesting that smoking and methadone effects may be inseparable dimensions. In
summary, the results of these studies suggest that in addition to physical symptoms, mood related factors are important to opioid withdrawal perception and that the mood factors and drug interactions can impact on a patient’s perception of satisfaction with methadone treatment.
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Morton, Erin Brooke. "The clinical pharmacology of methadone induction". Thesis, 2007. http://hdl.handle.net/2440/41434.
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Methadone is the foremost, long-standing pharmacological treatment for opioid addiction. It has been shown to have considerable cost benefit to the community and to decrease mortality. Despite methadone's decades-long use, much is still unknown regarding its clinical pharmacology, particularly during the induction phase of Methadone Maintenance Treatment (MMT).
Contrary to previous reports, I found systemic methadone clearance does not increase significantly between induction and steady state phases of MMT, and did not approach the previously reported 3-fold increase. Clinical dose prescription based on the premise of metabolism auto-induction could increase risk of respiratory depression.
Significant differences between R- and S-methadone pharmacokinetics showed the importance of stereoselective measurement in a clinical situation and significant plasma concentration-effect relationships demonstrated their potential influence on induction pharmacodynamics.
Small increases in CYP3A4 activity as measured by the Erythromycin Breath Test from Day 1 to Day 40 of MMT were not correlated with changes in methadone clearance. CYP3A4 activities were informative but would be insufficient for use as
a sole predictor of methadone clearance during MMT.
Clinically significant respiratory depression occurred in 20% of subjects, at times of peak plasma R-methadone concentrations, after reports of withdrawal symptoms at pre-dose sampling times, and irrespective of illicit opioid use. Utilisation of both respiratory rate and blood oxygen saturation measurements provided a good indication of respiratory risk for individuals.
Although prior opioid use was a strong predictor of continued use during MMT, adoption of a new equation ("abc") and comprehensive documentation of each individual's MMT may increase prediction of MMT success.
Even in light of recent advances in opioid substitution therapies, MMT's advantages ensure it is still at the forefront of addiction treatment. Careful choice of methodology enabled narrowing of this investigation to those factors most relevant in methadone pharmacology and most responsible for MMT success or failure, and therefore extending previous knowledge of this area. Such data might be utilised to develop a clinically applicable model for MMT, and help provide clients with a safe and uncomplicated transition from heroin use to methadone induction in the future.Thesis (Ph.D.) -- School of Medical Sciences, 2007
36
Morton, Erin Brooke. "The clinical pharmacology of methadone induction". 2007. http://hdl.handle.net/2440/41434.
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Methadone is the foremost, long-standing pharmacological treatment for opioid addiction. It has been shown to have considerable cost benefit to the community and to decrease mortality. Despite methadone's decades-long use, much is still unknown regarding its clinical pharmacology, particularly during the induction phase of Methadone Maintenance Treatment (MMT). Contrary to previous reports, I found systemic methadone clearance does not increase significantly between induction and steady state phases of MMT, and did not approach the previously reported 3-fold increase. Clinical dose prescription based on the premise of metabolism auto-induction could increase risk of respiratory depression. Significant differences between R- and S-methadone pharmacokinetics showed the importance of stereoselective measurement in a clinical situation and significant plasma concentration-effect relationships demonstrated their potential influence on induction pharmacodynamics. Small increases in CYP3A4 activity as measured by the Erythromycin Breath Test from Day 1 to Day 40 of MMT were not correlated with changes in methadone clearance. CYP3A4 activities were informative but would be insufficient for use as a sole predictor of methadone clearance during MMT. Clinically significant respiratory depression occurred in 20% of subjects, at times of peak plasma R-methadone concentrations, after reports of withdrawal symptoms at pre-dose sampling times, and irrespective of illicit opioid use. Utilisation of both respiratory rate and blood oxygen saturation measurements provided a good indication of respiratory risk for individuals. Although prior opioid use was a strong predictor of continued use during MMT, adoption of a new equation ("abc") and comprehensive documentation of each individual's MMT may increase prediction of MMT success. Even in light of recent advances in opioid substitution therapies, MMT's advantages ensure it is still at the forefront of addiction treatment. Careful choice of methodology enabled narrowing of this investigation to those factors most relevant in methadone pharmacology and most responsible for MMT success or failure, and therefore extending previous knowledge of this area. Such data might be utilised to develop a clinically applicable model for MMT, and help provide clients with a safe and uncomplicated transition from heroin use to methadone induction in the future.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1269301
Thesis (Ph.D.) -- School of Medical Sciences, 2007
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Stones, George. "Predicting Community-based Methadone Maintenance Treatment (MMT) Outcome". Thesis, 2012. http://hdl.handle.net/1807/34932.
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This was a retrospective study of a community-based methadone maintenance treatment (MMT) program in Toronto. Participants (N = 170) were federally sentenced adult male offenders admitted to this voluntary program between 1997 and 2009 while subject to community supervision following incarceration. The primary investigation examined correlates of treatment responsivity, with principal outcome measures including MMT clients’ rates of: (i) illicit drug use; and (ii) completion of conditional (parole) or statutory release (SR). For a subset (n = 74), recidivism rates were examined after a 9-year interval. Findings included strong convergent evidence from logistic regression and ROC analyses that an empirically and theoretically derived set of five variables was a stable and highly significant (p <.001) predictor of release outcome. Using five factors related to risk (work/school status, security level of releasing institution, total PCL-R score, history of institutional drug use, and days at risk), release outcome was predicted with an overall classification accuracy of 88%, with high specificity (86%) and sensitivity (89%). The logistic regression model generated an R2 of .55 and the accompanying AUC was .89, both substantial. Work/school status had an extremely large positive association with successful completion of community supervision, accounting for > half of the total variance explained by the five-factor model and increasing the estimated odds of successful release outcome by > 15-fold. Also, when in the MMT program, clients' risk taking behaviour was significantly moderated, with low overall base rates of illicit drug use, yet the rate of parole/SR revocation (71%) was high. The 9-year follow-up showed a high mortality rate (15%) overall. Revocation of release while in the MMT program was associated with a significantly higher rate and more violent recidivism at follow-up. Results are discussed within the context of: (a) Andrews' and Bonta's psychology of criminal conduct; (b) the incompatibility of a harm reduction treatment model with an abstinence-based parole decision-making model; (c) changing drug use profiles among MMT clients; (d) a strength-based approach to correctional intervention focusing on educational and vocational retraining initiatives; and (e) creation of a user friendly case-based screening algorithm for prediction of release outcome for new releases.
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Chang, Chih-Ting, i 張芝庭. "Factors for Interruption of Methadone Maintenance Treatment Patients". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/84195081417722515523.
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碩士中國醫藥大學
醫務管理學研究所碩士班
98
Research Purpose: According to researches that the maintenance rate is only about 50% after receiving MMT in domestic and foreign drug addicts. MMT curative effect has been proved, but so far few researchers have examined the factors for interruption of MMT cases. Therefore, in this study, we will examine the factors for interruption of Methadone Maintenance Treatment cases especially focusing on the significant differences caused by their individual characteristics, the factors involving them in the MMT project and factors for interruption of MMT project. Research Method: We used a self-administered, structured questionnaire to collect people, with their agreement, who participated in MMT project, and receiving treatment over three months in central Taiwan during 1998 July to December. There were 420 valid questionnaires (valid return rate is 79.8%).After receiving the questionnaire, we’ll check whether they interrupt MMT treatment. Then, we use chi-square test and independent-sample t test to inquire into the influence relationship of each variable. Finally, we use stepwise logistic regression analysis to find the important factors affecting the factors for interruption of MMT project. Research Results: The subjects tend to be male, their average age is 38.4 years old, the marriage status was unmarried, the education level was high school, the month income was under 18,000 dollars, employed, in a habit of smoking, a half of subjects have ever used Amphetamines, the average duration of using heroin is 13.02 years, the average quit drug times is 1.4, the time to MMT treatment is within 30 minutes. Advanced analysis found that age, educational level, changes in Methadone doses and the need of counseling for MMT subjects caused significantly differences for interruption on drug addicts. Conclusion and Suggestion: Overall, educational level and counseling need of drug addicts were the important factors affecting the interruption of MMT project. In order to reduce interruption of drug addiction treatment patients, we recommend that MMT hospitals and government agencies should have supporting measures for their friendship, work and mental need.
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Huang, Bo-Hau, i 黃柏豪. "Pharmacogenomics of Methadone in Patients with Maintenance Treatment". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/24391408731359633077.
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碩士中國醫藥大學
藥物安全研究所
98
The most common treatment for opioid dependence is substitution therapy with methadone, and the dosage of methadone is individualized. The aim of the present study is to identify whether the single nucleotide polymorphisms (SNP) or haplotypes in related genes associated with response to methadone maintenance treatment (MMT) and dosage requirement of methadone. After signed the informed consents, approximately 300 subjects were recruited and allocated into three groups according to their stabilized daily dose of methadone: the first group was comprised of subjects stabilized on a lower dose, the second group comprised of subjects stabilized at a medium dose, and the last group comprised of subjects stabilized at a higher dose. The decision to split the groups at a methadone dose was based on the major maintained dose of patients. The control group was healthy volunteers with no lifetime history of heroin dependence. In this study, there are 15 SNPs detected by real-time polymerase chain reaction with 5''-nuclease allele discrimination assays (ABI PRISM 7900 land) and restriction fragment length polymorphism (RFLP) assay in ABCB1, NR1I2, CYP2B6 genes (pharmacokinetics) and in OPRM1, DRD2, ANKK1, GNB3 genes (pharmacodynamics). As results, the maximum daily methadone doses were significantly assoiated with the ABCB1 rs1045642C>T, CYP 2B6 rs3745274G>T, OPRM1 rs1799971A>G, DRD2 rs1799978C>T and rs6275A>G SNPs. Carriers of the variant rs1799971G alleles required higher methadone doses than noncarriers. In addition, the subjects carried the CCGAC haplotype of ANKK1 rs1800497C>T, DRD2 rs4648317C>T, rs1799978 A>G, rs1076560 C>A, rs6275 C>T required significant lower dose than TTGAT haplotype (p<0.0001; OR=0.004; 95% CI=0.001-0.053). Pharmacogenetics has great potential for improving treatment outcome as we identify gene variants and polymorphism is recognized as important determinants of interindividual variability in methadone pharmacokinetics and pharmacodynamics.
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Wu, Shiow-Ling, i 吳秀玲. "HCV Influences the Methadone Maintenance Treatment for Addiction". Thesis, 2013. http://ndltd.ncl.edu.tw/handle/99395206054992693437.
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博士國防醫學院
生命科學研究所
102
Background and Objectives: Heroin-dependent patients typically contract hepatitis C virus (HCV) at a disproportionately high level due to needle exchange. The liver is the primary target organ of HCV infection and also the main organ responsible for drug metabolism. Methadone maintenance treatment (MMT) is a major treatment regimen for opioid dependence. HCV infection may affect methadone metabolism but this has rarely been studied. In our current study, we first established a method to measure the plasma concentrations of methadone and its metabolites under no enantiomer standard circumstances. We then aimed to test the hypothesis that HCV may influence the methadone dosage and its plasma metabolite concentrations in a MMT cohort from Taiwan. Methods: A liquid chromatography-photodiode array (LC-PDA) method using a chiral analytical column was developed to determine the plasma levels of enantiomers of methadone and its chiral metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine (EDDP), without the standard compounds of R-form or S-form enantiomers. This method was established by the characteristics of recombinant cytochrome P-450 (CYP) isozymes; where CYP2C19 prefers to metabolize R-methadone and CYP2B6 prefers to metabolize S-methadone. A total of 366 MMT patients were recruited and measured their plasma methadone and metabolite concentration. The levels of plasma hepatitis B virus (HBV), HCV, human immunodeficiency virus (HIV) antibodies (Ab), liver aspartate aminotransferase (AST) and alanine aminotransferase (ALT), as well as methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) were measured along with the urine morphine concentration and amphetamine screening. Results: We incubated the racemic methadone standard with either enzyme for 24 hours. We identified the retention times of R- and S-methadone to be around 10.72 and 14.46 min, respectively. Of the 352 subjects in our cohort with HCV test records, 95% were found to be positive for plasma anti-HCV antibody. The liver functional parameters of AST (Wilcoxon Rank-Sum test, P=0.02) and ALT (Wilcoxon Rank-Sum test, P=0.04), the plasma methadone concentrations (Wilcoxon Rank-Sum test, P=0.043) and the R-enantiomer of methadone concentrations (Wilcoxon Rank-Sum test, P=0.032) were significantly higher in the HCV antibody-positive subjects than in the HCV antibody-negative patients, but not the S-EDDP/ methadone dose ratio. The HCV levels correlated with the methadone dose ( = 14.65 and 14.13; P=0.029 and 0.03) and the S-EDDP/ methadone dose ratio ( = -0.41 and -0.40; P=0.00084 and 0.002) in both univariate and multivariate regression analyses. Conclusions: We conclude that HCV may influence the methadone dose and plasma S-EDDP/ methadone dose ratio in MMT patients in this preliminary study.
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MA, JUNG-LI, i 馬榮梨. "The Relationships of Medication Adherence in Methadone Maintenance Therapy". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/q2mz39.
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碩士輔英科技大學
護理系碩士班
104
Background: The adherence problems have often interrupted the treatment of methadone maintenance therapy, causing the relapse of heroin addiction and the increase of medical care expenses. The study probes into the related factors of adherence, expecting to provide a better strategy and reduce the waste of medical and social resources. Purposes: The study discusses the related factors of basic attributes of population, social supports, physical and mental condition, heroin rehabilitation and adherence. Methods: The study designed the self-administered questionnaires by Cross-Sectional and Descriptive study, and the methadone cases of a medical center in southern region were involved. During the research period from September to December in 2015, the addicted cases that had methadone treatment for over a month, accepted the interview and did not involve in deferred prosecution were included. The attendants filled out the questionnaires including basic attributes of population, family care scale, social support scale, anxiety scale, decision of rehabilitation scale, hesitating attitude toward methadone questionnaire, heroin treatment history and chronic disease investigation. The effective response rate reached 96%, and SPSS 19.0 statistical software was used for filing and data analysis. Results: 120 attendants completed the investigation, and most of the cases were in the age of 40-49, male, unmarried and junior high school as the highest education level. The subjects were grouped by the attendance above and under 80%. The related factors that influence the attendance include “gender” (x2=11.98、p=.001), where the female has a lower attendance than male; “use time of methadone” (t=2.214、p=.029): the longer the period of taking the methadone, the better the attendance; “anxiety - autonomic nervous reaction” (t=-2.249、p=.026): the stronger the anxiety reaction of autonomic nervous, the lower the attendance would be. Suggestion and conclusion: In the aspect of the clinic, it is suggested providing female-friendly environment for treatment, consider individual needs and strengthen the screening mechanism of psychical treatment. Introducing the study results in on-the-job education and improving the popularity of referring cases through inter-academic cooperation are both feasible for strategic guidance and future reference. Keywords: Methadone maintenance therapy, Heroin addiction, medication adherence
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YING-CHUN, CHOU, i 周盈君. "The Effectiveness of Methadone Maintenance Treatment in Northern Taiwan". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/31031139870843989980.
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碩士國立臺灣師範大學
健康促進與衛生教育學系
100
Objective: This paper examined the costs and the effectiveness before the Methadone Maintenance Treatment (MMT) and after one-year follow-up of MMT from patients’ perspective in four hospitals in northern Taiwan. Methods: The participants in this study were recruited from the population of outpatients with heroin addiction enrolled at methadone maintenance treatment program in four hospitals in northern Taiwan. We adopted costs and effectiveness from patients’ perspective. The WHOQOL-BREF and the employment status were administered at baseline and at one-year follow-up to calculate the incremental quality of life (QoL) gained and the wages differences. The averted incarceration costs were computed by the estimates from government reports or literatures and the criminal records from Ministry of Justice. Results: The implementation of MMT program cost were 37,989, 38,992 and 40,195 NT dollars from 2009 to 2011; however, without the implementation of MMT program, the cost was 672,954. The measurements for benefit were quality of life, employment, and criminal activities. The cost per QoL (Quality of Life) in physical health domain was the highest of four domains (24,214 NT dollars) and the cost per QoL in psychological health domain was the lowest (10,280 NT dollars). The unemployment rate decreased after one-year follow-up; however, the wages per hour slightly decreased. Compared with the year of 2004 to 2007, the intervention of MMT decreased criminal offenses and incarceration costs. Conclusions: During one-year follow-up of MMT, this study has shown that methadone maintenance treatment is cost-effective in terms of quality of life improvement, increased employment and averted incarceration costs.
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Changchien, Te-Chang, i 張簡德璋. "Erectile Dysfunction among Male Patients Receiving Methadone Maintenance Therapy". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/19804736913786699097.
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碩士樹德科技大學
人類性學研究所
103
Introduction: Methadone maintenance therapy is an effective treatment for patients of heroin use disorder. However, there are still some stigmatization and preoccupation from Chinese society, especially for those with Human Immunodeficiency Virus (HIV) infection. So we had little information about their sexual function, which could interfere adherence to treatment and quality of life. Because that heroin or even methadone might affect erectile function was hypothesized, we need to explore the actual prevalence and associated factors predicting erectile dysfunction (ED) in Taiwan in order to enhance their sexual right. Methods: A total of 450 men with diagnosis of heroin use disorder in the methadone clinic of E-Da Hospital, Kaohsiung City, Taiwan, were potentially eligible to participate in this study. Of these, 106 patients were recruited (including 13 patients with HIV infection) and were evaluated with International Index of Erectile Function-5 (IIEF-5), Taiwanese Depression Questionnaire (TDQ), Chinese Health Questionnaire (CHQ), Chinese CAGE screen for alcohol misuse, demographic data, HIV infection, risky sexual behaviors and substance use measures. Men who had no any sexual intercourse were excluded. Descriptive (by Chi-square test and T test) and inferential (by Pearson’s correlation and regression models) statistics were performed with SPSS. Results: There was no significant difference for demographic characteristics between the “new patient” group and the treatment group, except of more condom use and less sexual activities immediately after using drug in the treatment group. Similar findings were noted about the difference between HIV infection group and non-HIV group. HIV infection group had more sexual partners with drug use. As to mean scores of IIEF-5, CHQ and TDQ, no significant difference was detected between the “new patient” and the treatment groups. Besides, there was a negative correlation between IIEF-5 and CHQ (r=-0.319; p<0.01); between IIEF-5 and TDQ (r=-0.262; p<0.01). On multivariate regression models, common mental symptoms (CHQ) were associated with lower IIEF-5 (p=0.001), but there were no significant associations between IIEF-5 and age, body mass index (BMI), duration of methadone treatment, methadone dosage, TDQ, risky sexual behaviors, HIV or other illicit drug use. Tendency to have alcohol use problem was significantly associated with higher IIEF-5 (p=0.044). Conclusions: First, to the best of our knowledge, this is the first study, which focused on the ethnic Chinese patients co-morbided with heroin use disorder and HIV infection, to demonstrate associated risk factors of ED in Taiwan. Second, our finding about the prevalence of ED is lower and closer to previous studies in comparison with another three China studies (using IIEF-5 also). That perhaps reflected we indeed excluded nonsexually active patients. Because those patients would be evaluated as having severe ED while scoring IIEF-5. Finally, we need to promote the importance of common mental symptoms (including anxiety symptoms) on erectile dysfunction.
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SHIH, MENG-SIOU, i 施孟秀. "The Experiences of Heroin Addicts in Methadone Maintenance Treatment". Thesis, 2019. http://ndltd.ncl.edu.tw/handle/664h4j.
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Maruyama, Anna. "The Comparison of prescriptions dispensed for methadone maintenance patients to non-methadone maintenance patients for the treatment of chronic diseases using PharmaNet data". Thesis, 2012. http://hdl.handle.net/1828/4056.
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Context: Modifiable risk factors in older methadone maintenance treatment (MMT) patients may put them at a greater risk of acquiring chronic diseases. The paucity of literature regarding the well-being and service needs of older MMT patients required investigation to determine whether these patients are treated for and adhere to chronic disease medications(s) comparably to those not on MMT.
Objective: This study compared the proportion of MMT patients to a matched control group treated with first-line medications for four chronic diseases: hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus and depression. As a secondary outcome measure, this study also examined the adherence comparability between the two groups.
Method: This case control study used prescription claims data from the BC Ministry of Health’s PharmaNet database from October 1, 2008 to December 31, 2009. Each MMT patient was individually matched with a control subject in terms of age, sex, social assistance coverage and local health area. Both groups consisted of 143 men and 56 women for a total of 400 participants. Persons 50 years of age and older, residents of BC, and had prescriptions filled during October 1, 2008 to December 31, 2009, were randomly selected from the PharmaNet database.
Results: Odds ratios (ORs) were calculated to compare the odds of MMT patients to non-MMT patients on a first-line medication for each chronic disease under investigation. ORs were 0.865 for hypertension (ns), 0.738 for diabetes (ns) and 4.176 for depression (p <0.001). For COPD the OR could not be calculated as no controls were treated for COPD; however, 11.6% of the MMT group were prescribed COPD medications which was significantly higher than the controls (p<.001). Adherence was calculated using continuous measures of medication availability (CMA) “by patient” and “by medication class” during patients’ persistent periods (continuous use periods) CMA(1), as well as the entire study period CMA(2). By patient, the mean CMA(1) showed no difference between the groups (non-MMT group: 91.9%, SD=15.8, CI=95% vs MMT group: 89.7%, SD=22.2, CI=95%). The mean CMA(2) was statistically different (p<0.05) between the groups (non-MMT group: 70.5%, SD=25.3, CI=95% vs MMT group: 60.8%, SD=29.1, CI=95%). By medication class, CMA(1) was 80-100% for most medication classes for both groups except for insulins and inhalers in the MMT group which fell between 40-79%. The CMA(2) for most medication classes was 60-86% in the non-MMT group and 30-76% in the MMT group. However, the differences between the groups were not statistically significant.
Conclusion: Odds ratios for the treatment of all four chronic diseases differed. Therefore, looking at each chronic disease separately may be worthwhile to suggest potential targets for intervention. Disease-specific tailored interventions related to lifestyle risk factors, comorbid medical conditions, and adherence to chronic medications could potentially improve the overall health of older MMT patients. However, development of appropriate interventions and treatments requires research that properly recognizes the physical and mental health problems faced by older MMT patients (Rosen, Hunsaker, Albert, Cornelius, & Reynolds III, 2010).Graduate
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Tsai, Shu-Ho, i 蔡淑合. "Exporing Factors Related Methadone Maintenance Treatment among Injecting Drug Users". Thesis, 2009. http://ndltd.ncl.edu.tw/handle/pn4qd9.
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碩士國立陽明大學
護理學系暨研究所
97
Objectives: The aim of this study was to examine factors related methadone maintenance treatment among injecting drug users in Taiwan. Methods: The Study used a mixed research to collect qualitative and quantitative data. Conceptuial framework base on Andersen’s behavioural model of health care utilization . Structured Questionnaire were conduct with one hundred eighteen injecting drug uses and depth interviews were seventeen participants. Data obtained from the effectiveness investigation harm reduction plan in Taiwan . Results: In the predisposing factors: fear of the police investigation officers, for fear of boss knowing or encountered an acquaintance were obstructive factors; In the enabling factors: quantitative were shows the most goto hospitals period of time and the cost of methadone maintenance treatment was related with different regions; the depth qualitative interviews were mainly found: free charge , drugs friends of effects , improve of health、improve of family relations, economic improvement were facilitated factors ; On the contrary , convenience of location services, the continuity of medication, the cost is too expensive were obstructive factors. In the need factors, qualitative finding : the experience of the failure of drug use are facilitated factors., and the period in the ring , they still use of heroin were barrier factors.; the research common finding the quality of personal life to improve the economic. Conclusion: Andersen model’s predisposing factors, enabling factors and needs factors have playing important roles in injecting drug users to regular use methadone maintenance treatment for improved of health status, family and economics.
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Chen, I.-Chun, i 陳逸群. "Alcohol Use Problem among Patients in Methadone Maintenance Treatment Program". Thesis, 2009. http://ndltd.ncl.edu.tw/handle/55375671862737905259.
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碩士國立臺灣大學
預防醫學研究所
97
OBJECTIVE: To examine the prevalence rate and predictors of alcohol use problem, as well as predictors of dropout among patients undergoing methadone maintenance treatment (MMT). Alcohol use problem is defined as two levels separately, level one is excessive and hazardous drinking, level two is alcohol abuse and dependence. METHODS: This is a prospective follow-up study. Study population includes 438 patients retaining more than 6 months in MMT from the Fong-Yuan Hospital and Tau-Yuan Psychiatric Center. Demographic and clinical characteristics were collected for each patient at the beginning, and treatment-related variables were collected during treatment process. Excessive drinking and hazardous drinking, alcohol abuse and dependence were measured by Chinese Version Alcohol Use Disorders Identification Test (Chinese Version AUDIT) and breath alcohol concentration. RESULT: The prevalence rate of excessive drinking and hazardous drinking among MMT patients is 31.4%, and the prevalence rate of alcohol abuse and dependence is 12.0%. The predictors of excessive and hazardous drinking among MMT patients include attendance rate more than 90%（OR=0.54，95%CI=0.30-0.97）, age older than 35 years old（OR=0.48，95%CI=0.27-0.86）,and alcohol use at intake（OR=5.30，95%CI=2.87-9.76） is a risk factor. The predictors of dropout among MMT patients include methadone dose less than 60 mg (Wald test p-value<0.001), without governmental fund (Wald test p-value<0.001). CONCLUSION：The high prevalence rate of excessive and hazardous drinking among MMT patients underscores the needful screening and intervention for alcohol use problem .Those patients who are younger and have poor adherence, alcohol use at intake should be screened for excessive and hazardous drinking.
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Wu, Mei-Hui, i 吳美惠. "Quality of Life for Heroin Addicts accepting Methadone maintenance treatment". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/29562247497471306833.
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碩士中臺科技大學
健康產業管理研究所
99
With Methadone Maintenance Therapy (MMT), this study aims to discuss the difference in the quality of life (QOL) for heroin addicts so as to draw up a health management project for heroin addicts. With the single time-series design in Quasi-experimental design, the differences in QOL before applying MMT and three and six months after using are compared. With 320 patients who accepted MMT in central Taiwan as the subjects, three interviews were preceded within April – November, 2010. Based on the World Health Organization (WHO) QOL questionnaire– Brief reference for Taiwan (WHOQOL-BREF (TW)), the quality of life was measured. The findings show male (91.56％), female (8.44％), and average age 39.68 years old; the educational background below junior high school 60.00％; unemployed 47.19％; single 45.94％, having fixed abode 94.38％; average age for first use of drugs 24.13 years old; average age for first use of heroin 26.03 years old; having heroin with intravenous injection 80.00％; average use of heroin 3.20 times each day; average expense on heroin 3,910 NT dollars each day; average use of half mace of heroin 5.4 days; sharing needles with others 11.25%, sharing preparation solution injection with others 18.44%; infected with human immune deficiency virus (HIV) 22.81%; suffering from Hepatitis C 85.31％; and having prior convictions on drugs 74.69％. It is concluded that most patients accepting MMT are middle-aged, unemployed male with the educational background of junior high school, having heroin with intravenous injection, and 85% suffering from Hepatitis C. Six months after the heroin addicts accepting MMT, overall and physiological health, psychology, social relations, and environment in QOL presented better than they did before and three months after the therapy. Apparently, continuously accepting MMT could effectively improve the quality of life. The heroin addicts are suggested to patiently and permanently accept MMT to put an end to the use of heroin as well as to promote the quality of life.
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Su, Ting-Yu, i 蘇亭羽. "Genetic variation analysis of Methadone Maintenance Treatment for Heroin Addicts". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/8rgpd4.
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Doverty, Mark. "Acute pain management in methadone maintenance treatment / by Mark Doverty". Thesis, 2001. http://hdl.handle.net/2440/21876.
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"December 2001"Includes bibliography.
1 v. (various paging) : ill. ; 30 cm
In the light of a general concensus that in the treatment of pain, patients with a prior history of substance abuse (particulary opioid dependence) appear to be at increased risk for pain mismanagement problems, this thesis aims to produce data that will eventually help in the formulation of prescribing guidelines, improved policies, and help direct optimal acute pain management for methadone maintenance patients.
Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical and Experimental Pharmacology, 2002