ABSTRACT
Patients in a methadone maintenance clinic were randomly assigned to two groups: one to have urine tests on-site (by the EMIT system) with immediate feedback of results to patients and staff; the other to have urine specimens sent away to an offsite laboratory for testing by thin-layer chromatography. Although other advantages might justify the adoption of on-site testing in methadone programs, the method appeared to have little or no therapeutic advantage over customary off-site testing. There were negligibly small differences between the groups with respect to illicit drug use.
Subject(s)
Heroin Dependence/rehabilitation , Heroin/urine , Methadone/therapeutic use , Adult , Chromatography, Thin Layer , Consumer Behavior , Feedback , Female , Humans , Immunoassay , Male , Patient Compliance , Time FactorsABSTRACT
Sixty-six patients participated in a double-blind, crossover study comparing side effects, drug use, clinic attendance, and dose changes on levomethadone and d,l (racemic) methadone. The hypothesis under examination was that dextromethadone, while adding no narcotic actions to the racemate, was contributing to side effects. An earlier single-blind pilot study showed that 9 out of 11 side effects improved while patients were receiving levomethadone, but this larger study did not duplicate those results. Analysis of 25 variables showed no significant between levo- and racemic methadone. There appears to be no advantage in levomethadone over racemic methadone in the treatment of patients in maintenance programs.
Subject(s)
Methadone/adverse effects , Clinical Trials as Topic , Heroin Dependence/drug therapy , Humans , Methadone/therapeutic use , Stereoisomerism , Taste , Time FactorsABSTRACT
Patients in a methadone clinic were given knowledge and control of their own dosages. Dosages could be changed by 5 mg/week, but if more than 50 mg was used, no take-home privileges were allowed. The maximum dosage permitted was 120 mg. Plasma methadone levels were determined for some patients. The result of the study was that there was little dosage change, with the median dosage increasing from 40 to 50 mg at the end of six months. A small group of patients did raise their dosages systematically, and these patients tended to decrease illicit opiate use. There was no indication that these patients had abnormally low plasma methadone levels. At the end of six months, patients and staff overwhelmingly preferred an open-dose self-adjustment system over the usual procedure of dosage management by professional staff and dosage changes achieved by negotiation.
Subject(s)
Community Participation , Methadone/administration & dosage , Evaluation Studies as Topic , Humans , Informed Consent , Methadone/blood , Methadone/therapeutic use , Substance Withdrawal Syndrome/prevention & controlABSTRACT
Plasma methadone levels, symptom complaints, and urine tests for illicit opiate use were followed weekly in 17 patients on a methadone maintenance program. There were very large differences between patients in the plasma level established at a given dosage, implying large differences in the rate of methadone metabolism. Despite virtually constant daily dosage, the plasma methadone levels fluctuated greatly from week to week and from day to day in individual patients. With rate exceptions there was no relationship between plasma methadone level and symptom complaints or between weekly chamges in plasma methadone level and changes in symptom complaints. Except possible to identify the ocassional patient with unusually low plasam methadone levels, the determination of methadone levels is not likely to be or practical value in methadone programs.
