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.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/17756 |
| Date | 24 September 2009 |
| Creators | Elkader, Alexander |
| Contributors | Sproule, Beth |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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