The Opiate Dosage Adequacy Scale for Identification of the Right Methadone Dose--a Prospective Cohort Study

Overview

Journal BMC Pharmacol Toxicol

Publisher Biomed Central

Specialty Pharmacology

Date 2016 Apr 8

PMID 27052201

Citations 6

Authors

Stephan Walcher

John Koc

Volker Reichel

Frank Schlote

Uwe Verthein

Jens Reimer

Affiliations

Soon will be listed here.

Abstract

Background: Opioid maintenance treatment with methadone is regarded as gold standard in the therapy of opioid dependence. Identification of the 'right' methadone dose, however, remains challenging. We wanted to explore if the Opiate Dosage Adequacy Scale (ODAS) is a helpful instrument in methadone titration.

Methods: Within this 12-months prospective naturalistic cohort study patients in stable maintenance treatment with methadone (Eptadone®) were included. Sociodemographic and clinical data were gathered at baseline, and months 3, 6, and 12. At the same points in time, the instruments ODAS, European Addiction Severity Index (EuropASI), and Derogatis Interview for Sexual Functioning-Self Report (DISF-SR) were applied.

Results: Five hundred fifteen patients were enrolled, 129 patients prematurely terminated substitution treatment (treatment failure), in 108 patients substitution medication was changed, likely due to bitter taste of Eptadone®. Complete longitudinal ODAS and EuropASI data sets were available for 229 patients. The frequency of adequate methadone doses (ODAS) increased (60.9 % at baseline, 85.3 % at month 12) as well as the average daily methadone dose (63.8 (±30.8) mg/day at baseline to 69.6 (±36.0) mg/day at month 12). Inadequacy of methadone dose was not associated with treatment failure (RR 1.019; CI 95 % 0.756-1.374). Addiction severity decreased statistically significantly. Compared to adequately dosed patients, inadequately dosed patients benefited more, in that they showed greater improvements in ODAS scores, had higher increases in methadone dose, and partially experienced more advanced sexual functioning.

Conclusion: Application of ODAS was associated with improved methadone dose adequacy and addiction severity parameters as well as increased methadone doses. Its usefulness should be corroborated in a controlled trial.

Citing Articles

Methadone maintenance treatment alters couplings of default mode and salience networks in individuals with heroin use disorder: A longitudinal self-controlled resting-state fMRI study.

Chen J, Li Y, Wang S, Li W, Liu Y, Jin L Front Psychiatry. 2023; 14:1132407.

PMID: 37139328 PMC: 10149709. DOI: 10.3389/fpsyt.2023.1132407.

Changes in daily dose in open-label compared to double-blind: The role of clients' expectations in injectable opioid agonist treatment.

Blawatt S, Arreola L, Magel T, MacDonald S, Harrison S, Schechter M Addict Behav Rep. 2023; 17:100490.

PMID: 37124402 PMC: 10140796. DOI: 10.1016/j.abrep.2023.100490.

Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years.

Ivasiy R, Madden L, Farnum S, Shumskaya N, Galvez de Leon S, Bromberg D Drug Alcohol Depend Rep. 2022; 4.

PMID: 36267100 PMC: 9581459. DOI: 10.1016/j.dadr.2022.100075.

Evaluation of functional status among patients undergoing maintenance treatments for opioid use disorders.

Ruiz Ruiz J, Martinez Delgado J, Garcia-Marchena N Harm Reduct J. 2021; 18(1):41.

PMID: 33849574 PMC: 8042937. DOI: 10.1186/s12954-021-00488-2.

The real-world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine.

Farnum S, Makarenko I, Madden L, Mazhnaya A, Marcus R, Prokhorova T Addiction. 2020; 116(1):83-93.

PMID: 32428276 PMC: 7674222. DOI: 10.1111/add.15115.

References

Farrell M, Ward J, Mattick R, Hall W, Stimson G, Des Jarlais D . Methadone maintenance treatment in opiate dependence: a review. BMJ. 1994; 309(6960):997-1001. PMC: 2541312. DOI: 10.1136/bmj.309.6960.997. View

van den Brink W, Haasen C . Evidenced-based treatment of opioid-dependent patients. Can J Psychiatry. 2006; 51(10):635-46. DOI: 10.1177/070674370605101003. View

Reimer J, Boniakowski E, Bachner C, Weber B, Tietje W, Verthein U . When higher doses in opioid replacement treatment are still inadequate - association to multidimensional illness severity: a cohort study. Subst Abuse Treat Prev Policy. 2014; 9:13. PMC: 3975916. DOI: 10.1186/1747-597X-9-13. View

Teusch L, Scherbaum N, Bohme H, Bender S, Gastpar M . Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate.... Pharmacopsychiatry. 1995; 28(3):84-92. DOI: 10.1055/s-2007-979596. View

Brown R, Balousek S, Mundt M, Fleming M . Methadone maintenance and male sexual dysfunction. J Addict Dis. 2005; 24(2):91-106. DOI: 10.1300/J069v24n02_08. View

Shahiwala A . Formulation approaches in enhancement of patient compliance to oral drug therapy. Expert Opin Drug Deliv. 2011; 8(11):1521-9. DOI: 10.1517/17425247.2011.628311. View

Mattick R, Breen C, Kimber J, Davoli M . Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014; (2):CD002207. PMC: 10617756. DOI: 10.1002/14651858.CD002207.pub4. View

Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M . Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction. 2010; 106(1):32-51. DOI: 10.1111/j.1360-0443.2010.03140.x. View

Soyka M, Trader A, Klotsche J, Haberthur A, Buhringer G, Rehm J . Criminal behavior in opioid-dependent patients before and during maintenance therapy: 6-year follow-up of a nationally representative cohort sample. J Forensic Sci. 2012; 57(6):1524-30. DOI: 10.1111/j.1556-4029.2012.02234.x. View

10.

Spring Jr W, Willenbring M, Maddux T . Sexual dysfunction and psychological distress in methadone maintenance. Int J Addict. 1992; 27(11):1325-34. DOI: 10.3109/10826089209047354. View

11.

Schiff M, Levit S, Moreno R . Retention and illicit drug use among methadone patients in Israel: a gender comparison. Addict Behav. 2007; 32(10):2108-19. DOI: 10.1016/j.addbeh.2007.01.010. View

12.

Scheurich A, Muller M, WETZEL H, Anghelescu I, Klawe C, Ruppe A . Reliability and validity of the German version of the European Addiction Severity Index (EuropASI). J Stud Alcohol. 2001; 61(6):916-9. DOI: 10.15288/jsa.2000.61.916. View

13.

Trujols J, Sinol N, Perez de Los Cobos J . Methadone maintenance treatment: the need to distinguish between holding dose, dose adequacy, satisfaction with methadone as a medication, and satisfaction with treatment. J Clin Psychopharmacol. 2010; 30(1):95-6. DOI: 10.1097/JCP.0b013e3181c8b439. View

14.

Faggiano F, Vigna-Taglianti F, Versino E, Lemma P . Methadone maintenance at different dosages for opioid dependence. Cochrane Database Syst Rev. 2003; (3):CD002208. DOI: 10.1002/14651858.CD002208. View

15.

Verthein U, Schafer I, Degkwitz P . [Social integration after 4 years of heroin-assisted treatment]. Rehabilitation (Stuttg). 2012; 52(4):243-50. DOI: 10.1055/s-0032-1323663. View

16.

Gibson A, Degenhardt L, Mattick R, Ali R, White J, OBrien S . Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008; 103(3):462-8. DOI: 10.1111/j.1360-0443.2007.02090.x. View

17.

Roux P, Lions C, Michel L, Cohen J, Mora M, Marcellin F . Predictors of non-adherence to methadone maintenance treatment in opioid-dependent individuals: implications for clinicians. Curr Pharm Des. 2013; 20(25):4097-105. DOI: 10.2174/13816128113199990623. View

18.

Wittchen H, Apelt S, Soyka M, Gastpar M, Backmund M, Golz J . Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: a naturalistic study in 2694 patients. Drug Alcohol Depend. 2008; 95(3):245-57. DOI: 10.1016/j.drugalcdep.2008.01.015. View

19.

DeRogatis L . The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther. 1997; 23(4):291-304. DOI: 10.1080/00926239708403933. View

20.

Reimer J, Verthein U, Karow A, Schafer I, Naber D, Haasen C . Physical and mental health in severe opioid-dependent patients within a randomized controlled maintenance treatment trial. Addiction. 2011; 106(9):1647-55. DOI: 10.1111/j.1360-0443.2011.03463.x. View