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Current Psychopharmacology

Editor-in-Chief

ISSN (Print): 2211-5560
ISSN (Online): 2211-5579

Research Article

Methadone Contrasted with Acetaminophen Codeine Plus Clonidine: An Inpatient Pilot Study

Author(s): Saeed Shoja Shafti*

Volume 11, Issue 1, 2022

Published on: 23 August, 2021

Article ID: e230821195783 Pages: 7

DOI: 10.2174/2211556010666210823121451

Price: $65

Abstract

Introduction: The mainstay of pharmacological management of opioid dependence is opioid substitution treatment. Methadone is a long-acting opioid agonist, which is used for detoxification and maintenance of opioid-dependent people.

Objective: Objective of the present evaluation included a comparison between methadone and acetaminophen codeine plus clonidine for management of opioid withdrawal symptoms.

Methods: All patients of an acute ward of a psychiatric hospital, who met dual diagnosis of primary psychiatric disorder plus opioid use disorder, were selected as accessible sample for the current evaluation. Duration of assessment was around eleven months and the study was performed according to a single-blind plan. Among 96 patients, cases, who were using methadone, before their recent admission in hospital, continued their substitution treatment according to the recommended dosage and formulation till release (n = 42). The remaining group of patients, had been given acetaminophen codeine plus clonidine, as substitution treatment, during their inpatient management (n = 54). The primary outcome measures were the ‘Cross-Cutting Symptom Measure’ and the ‘Subjective Opiate Withdrawal Scale’, which were scored at baseline, week 1 and week 2. The study was performed according to the ‘per-protocol’ analysis, and the assessor was blind with respect to the said protocols.

Results: While the mean total score of primary outcome measures decreased significantly in both groups, the between-group analysis did not show any significant difference between these two groups in a head-to-head analysis.

Conclusion: Acetaminophen codeine plus clonidine was as good as methadone for management of opioid withdrawal symptoms in inpatient setting.

Keywords: Methadone, acetaminophen codeine, clonidine, detoxification, substance abuse, opioid.

Graphical Abstract

[1]
Noble F, Marie N. Management of opioid addiction with opioid substitution treatments: beyond methadone and buprenorphine. Front Psych 2019; 9: 742.
[http://dx.doi.org/10.3389/fpsyt.2018.00742] [PMID: 30713510]
[2]
Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 2012; 26(7): 899-952.
[http://dx.doi.org/10.1177/0269881112444324] [PMID: 22628390]
[3]
Luo SX, Bisaga A. Opioid use and related disorders: from neuroscience to treatment. In: Sadock B, Sadock VA, Ruiz P, Eds. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 10th ed. Philadelphia: Wolters Kluwer 2017; p. 3485.
[4]
Frances RJ, Miller SI, Mack AH, Eds. Clinical textbook of addictive disorders 3rd ed. New York: The Guildford Press 2011.
[5]
Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 2013; 170(8): 834-51.
[http://dx.doi.org/10.1176/appi.ajp.2013.12060782] [PMID: 23903334]
[6]
Krenek M, Maisto SA. Life events and treatment outcomes among individuals with substance use disorders: a narrative review. Clin Psychol Rev 2013; 33(3): 470-83.
[http://dx.doi.org/10.1016/j.cpr.2013.01.012] [PMID: 23454221]
[7]
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014; 2(2): CD002207.
[http://dx.doi.org/10.1002/14651858.CD002207.pub4] [PMID: 24500948]
[8]
Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016; (5): CD011117.
[http://dx.doi.org/10.1002/14651858.CD011117.pub2] [PMID: 27157143]
[9]
Sigmon SC, Bisaga A, Nunes EV, O’Connor PG, Kosten T, Woody G. Opioid detoxification and naltrexone induction strategies: recommendations for clinical practice. Am J Drug Alcohol Abuse 2012; 38(3): 187-99.
[http://dx.doi.org/10.3109/00952990.2011.653426] [PMID: 22404717]
[10]
Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database Syst Rev 2013; 2(2): CD003409.
[http://dx.doi.org/10.1002/14651858.CD003409.pub4] [PMID: 23450540]
[11]
Bell J. Pharmacological maintenance treatments of opiate addiction. Br J Clin Pharmacol 2014; 77(2): 253-63.
[http://dx.doi.org/10.1111/bcp.12051] [PMID: 23210630]
[12]
Gowing L, Ali R, White JM, Mbewe D. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev 2017; 2: CD002025.
[PMID: 28220474]
[13]
Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ 2010; 341: c5475.
[http://dx.doi.org/10.1136/bmj.c5475] [PMID: 20978062]
[14]
Gao L, Dimitropoulou P, Robertson JR, McTaggart S, Bennie M, Bird SM. Risk-factors for methadone-specific deaths in Scotland’s methadone-prescription clients between 2009 and 2013. Drug Alcohol Depend 2016; 167: 214-23.
[http://dx.doi.org/10.1016/j.drugalcdep.2016.08.627] [PMID: 27593969]
[15]
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Torsade de pointes associated with very-high-dose methadone. Ann Intern Med 2002; 137(6): 501-4.
[http://dx.doi.org/10.7326/0003-4819-137-6-200209170-00010] [PMID: 12230351]
[16]
Kornick CA, Kilborn MJ, Santiago-Palma J, et al. QTc interval prolongation associated with intravenous methadone. Pain 2003; 105(3): 499-506.
[http://dx.doi.org/10.1016/S0304-3959(03)00205-7] [PMID: 14527710]
[17]
Martell BA, Arnsten JH, Ray B, Gourevitch MN. The impact of methadone induction on cardiac conduction in opiate users. Ann Intern Med 2003; 139(2): 154-5.
[http://dx.doi.org/10.7326/0003-4819-139-2-200307150-00021] [PMID: 12859171]
[18]
Mayet S, Gossop M, Lintzeris N, Markides V, Strang J. Methadone maintenance, QTc and torsade de pointes: who needs an electrocardiogram and what is the prevalence of QTc prolongation? Drug Alcohol Rev 2011; 30(4): 388-96.
[http://dx.doi.org/10.1111/j.1465-3362.2010.00237.x] [PMID: 21355918]
[19]
Isbister GK, Page CB. Drug induced QT prolongation: the measurement and assessment of the QT interval in clinical practice. Br J Clin Pharmacol 2013; 76(1): 48-57.
[http://dx.doi.org/10.1111/bcp.12040] [PMID: 23167578]
[20]
Pani PP, Trogu E, Maremmani I, Pacini M. QTc interval screening for cardiac risk in methadone treatment of opioid dependence. Cochrane Database Syst Rev 2013; 6(6): CD008939.
[http://dx.doi.org/10.1002/14651858.CD008939.pub2] [PMID: 23787716]
[21]
Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 2005; 294(8): 903-13.
[http://dx.doi.org/10.1001/jama.294.8.903] [PMID: 16118380]
[22]
Gibson A, Degenhardt L, Mattick RP, Ali R, White J, O’Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction 2008; 103(3): 462-8.
[http://dx.doi.org/10.1111/j.1360-0443.2007.02090.x] [PMID: 18190664]
[23]
Neumann AM, Blondell RD, Jaanimägi U, et al. A preliminary study comparing methadone and buprenorphine in patients with chronic pain and coexistent opioid addiction. J Addict Dis 2013; 32(1): 68-78.
[http://dx.doi.org/10.1080/10550887.2012.759872] [PMID: 23480249]
[24]
Oliva EM, Trafton JA, Harris AH, Gordon AJ. Trends in opioid agonist therapy in the Veterans Health Administration: is supply keeping up with demand? Am J Drug Alcohol Abuse 2013; 39(2): 103-7.
[http://dx.doi.org/10.3109/00952990.2012.741167] [PMID: 23421571]
[25]
Abrahamsson T, Berge J, Öjehagen A, Håkansson A. Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study. Drug Alcohol Depend 2017; 174: 58-64.
[http://dx.doi.org/10.1016/j.drugalcdep.2017.01.013] [PMID: 28315808]
[26]
Sadock BJ, Sadock VA, Ruiz P, Eds. Substance Use and Addictive Disorders. Kaplan & Sadock’s Synopsis of Psychiatry. 11th ed. Philadelphia: Lippincott Wolters Kluwer 2015; pp. 659-66.
[27]
Renner JA, Suzuki J. Opiates and prescription drugs.Addiction medicine: science and practice. New York: Springer, LLC 2011; Vol. 1: p. 463.
[28]
Pierce M, Bird SM, Hickman M, et al. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction 2016; 111(2): 298-308.
[http://dx.doi.org/10.1111/add.13193] [PMID: 26452239]
[29]
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association 2013; pp. 734-41.
[30]
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310(20): 2191-4.
[http://dx.doi.org/10.1001/jama.2013.281053] [PMID: 24141714]
[31]
Handelsman L, Cochrane KJ, Aronson MJ, Ness R, Rubinstein KJ, Kanof PD. Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse 1987; 13(3): 293-308.
[http://dx.doi.org/10.3109/00952998709001515] [PMID: 3687892]
[32]
Barry DT, Beitel M, Cutter CJ, Joshi D, Falcioni J, Schottenfeld RS. Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: a needs assessment study. J Addict Med 2010; 4(2): 81-7.
[http://dx.doi.org/10.1097/ADM.0b013e3181ac913a] [PMID: 21769025]
[33]
Gros DF, Milanak ME, Brady KT, Back SE. Frequency and severity of comorbid mood and anxiety disorders in prescription opioid dependence. Am J Addict 2013; 22(3): 261-5.
[http://dx.doi.org/10.1111/j.1521-0391.2012.12008.x] [PMID: 23617869]
[34]
Marino EN, Rosen KD, Gutierrez A, Eckmann M, Ramamurthy S, Potter JS. Impulsivity but not sensation seeking is associated with opioid analgesic misuse risk in patients with chronic pain. Addict Behav 2013; 38(5): 2154-7.
[http://dx.doi.org/10.1016/j.addbeh.2013.01.020] [PMID: 23454878]
[35]
Martins SS, Keyes KM, Storr CL, Zhu H, Chilcoat HD. Pathways between nonmedical opioid use/dependence and psychiatric disorders: results from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend 2009; 103(1-2): 16-24.
[http://dx.doi.org/10.1016/j.drugalcdep.2009.01.019] [PMID: 19414225]
[36]
Saxon AJ, Ling W, Hillhouse M, et al. Buprenorphine/naloxone and methadone effects on laboratory indices of liver health: a randomized trial. Drug Alcohol Depend 2013; 128(1-2): 71-6.
[http://dx.doi.org/10.1016/j.drugalcdep.2012.08.002] [PMID: 22921476]
[37]
Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. EXCLI J 2015; 14: 577-600.
[PMID: 26869865]
[38]
Bart G, Wyman Z, Wang Q, Hodges JS, Karim R, Bart BA. Methadone and the QTc interval: paucity of clinically significant factors in a retrospective cohort. J Addict Med 2017; 11(6): 489-93.
[http://dx.doi.org/10.1097/ADM.0000000000000353] [PMID: 28863009]
[39]
Kakko J, Svanborg KD, Kreek MJ, Heilig M. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet 2003; 361(9358): 662-8.
[http://dx.doi.org/10.1016/S0140-6736(03)12600-1] [PMID: 12606177]
[40]
Sees KL, Delucchi KL, Masson C, et al. Methadone maintenance vs. 180-day psychosocially enriched detoxification for treatment of opioid dependence: A randomized controlled trial. JAMA 2000; 283(10): 1303-10.
[http://dx.doi.org/10.1001/jama.283.10.1303] [PMID: 10714729]
[41]
Wright N, D’Agnone O, Krajci P, et al. Addressing misuse and diversion of opioid substitution medication: Guidance based on systematic evidence review and real-world experience. J Public Health (Oxf) 2016; 38(3): e368-74.
[http://dx.doi.org/10.1093/pubmed/fdv150] [PMID: 26508767]
[42]
Mégarbane B, Hreiche R, Pirnay S, Marie N, Baud FJ. Does high- dose buprenorphine cause respiratory depression? Possible mechanisms and therapeutic consequences. Toxicol Rev 2006; 25(2): 79-85.
[http://dx.doi.org/10.2165/00139709-200625020-00002] [PMID: 16958555]
[43]
Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study. PLoS Med 2017; 14(10): e1002396.
[http://dx.doi.org/10.1371/journal.pmed.1002396] [PMID: 28972983]
[44]
Allouche S, Le Marec T, Coquerel A, Noble F, Marie N. Striatal dopamine D1 and D2 receptors are differentially regulated following buprenorphine or methadone treatment. Psychopharmacology (Berl) 2015; 232(9): 1527-33.
[http://dx.doi.org/10.1007/s00213-014-3785-x] [PMID: 25358852]
[45]
Ghosh A, Basu D, Avasthi A. Removed hyperlink field buprenorphine-based opioid substitution therapy in India: a few observations. Thoughts Opin 2018; 60(3): 361-6.
[46]
Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017; 357: 1550.
[http://dx.doi.org/10.1136/bmj.j1550] [PMID: 28446428]

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