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| ====== Methadone Clinics====== | ====== Methadone Clinics====== | ||
| - | {{:anorexia_ppt.pptx|}} | + | {{:methadone_clinic.pptx|}} |
| + | {{ :a-look-inside-a-methadone-clinic.jpg |}} | ||
| + | <div style="text-align: center;">Marden, D. (2016). Western NC Harm Reduction: A Look Inside a Methadone Clinic. Retrieved from https://sobernation.com/western-nc-harm-reduction-a-look-inside/> | ||
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| The two main types of clinics are public and private. Public are cheaper and longer waits, private are better equipped. In Canada, free consultation but a cost of $5-15 for the medication each time <sup>5</sup>. | The two main types of clinics are public and private. Public are cheaper and longer waits, private are better equipped. In Canada, free consultation but a cost of $5-15 for the medication each time <sup>5</sup>. | ||
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| + | <box 30%| > {{ :methadoneuses.png?nolink&400|}} </box| Figure 5: Uses of methadone for treatment [[https://www.confirmbiosciences.com/wp-content/uploads/2018/02/methadone-graphic-3-01.png]] > | ||
| Goals of a Methadone Clinic <sup>5</sup>: | Goals of a Methadone Clinic <sup>5</sup>: | ||
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| === Reduction In Opioid Usage === | === Reduction In Opioid Usage === | ||
| - | The implementation of the methadone maintenance treatment to help addicts reduce the use of heroin is a highly controversial topic with many viewpoints and justifications. Regardless of opposing views, the effectiveness of this treatment cannot be neglected. Considering that methadone maintenance is not a curative method of treatment, but rather a corrective one, evidence shows it to be medically safe and preferred <sup>6</sup>. | + | The implementation of the methadone maintenance treatment to help addicts reduce the use of heroin is a highly controversial topic with many viewpoints and justifications. Regardless of opposing views, the effectiveness of this treatment cannot be neglected. Considering that methadone maintenance is not a curative method of treatment, but rather a corrective one, evidence shows it to be medically safe and preferred <sup>7</sup>. |
| - | Firstly, this method can be deemed effective with its characteristic of reducing opioid usage. From when the methadone maintenance method was introduced to now, the use of this treatment to cope with opioid dependence has been an area of interest for researchers. A meta-analysis that was published in 1998 by Marsch found a statistically significant correlation between the methadone maintenance treatment and opioid use reduction. Similarly, a more current meta-analysis published in 2007 came to supporting conclusions. Ultimately, a decreasing pattern in opioid dependency can be seen in addicts when the methadone treatment is administered, based on the findings of randomized controlled trials analyzed in these meta-analyses <sup>3</sup>. When drawing conclusions about the effectiveness of this treatment, it is important to consider that reductions in opioid abuse depends on whether an appropriate dosage of methadone administered to addicts. Additionally, the maintenance of the reduction depends on the time period that addicts receive methadone. Therefore, it can be concluded that, with proper dosage and consistency of the methadone treatment, addicts are able to overcome their opioid-abusive behaviour. | + | Firstly, this method can be deemed effective with its characteristic of reducing opioid usage. From when the methadone maintenance method was introduced to now, the use of this treatment to cope with opioid dependence has been an area of interest for researchers. A meta-analysis that was published in 1998 by Marsch found a statistically significant correlation between the methadone maintenance treatment and opioid use reduction. Similarly, a more current meta-analysis published in 2007 came to supporting conclusions. Ultimately, a decreasing pattern in opioid dependency can be seen in addicts when the methadone treatment is administered, based on the findings of randomized controlled trials analyzed in these meta-analyses <sup>4</sup>. When drawing conclusions about the effectiveness of this treatment, it is important to consider that reductions in opioid abuse depends on whether an appropriate dosage of methadone administered to addicts. Additionally, the maintenance of the reduction depends on the time period that addicts receive methadone. Therefore, it can be concluded that, with proper dosage and consistency of the methadone treatment, addicts are able to overcome their opioid-abusive behaviour<sup>15</sup>. |
| === Methadone Compared to Other Options === | === Methadone Compared to Other Options === | ||
| - | Moreover, studies have found the methadone maintenance treatment to be more effective compared to alternative treatments. In a controlled trial study that compared Buprenorphine and Methadone maintenance in treating opioid dependence, the findings suggested methadone to be more effective than buprenorphine <sup>9</sup>. A double-blinded study was conducted with two hundred twenty-five opioid addicts seeking treatment by placing them in one of three groups: 8 mg/d of buprenorphine, 30 mg/d of methadone, or 80 mg/d of methadone maintenance over a one-year timespan. Efficacy was measured by observing both objective and subjective outcomes at middle and end of the study period. These measures included urine toxicology, retention, craving, withdrawal symptoms, and safety data <sup>9</sup>. The results of the study suggest that the high dose methadone treatment showed significant improvements in retention, and opioid use and cravings, compared to both the low-dose methadone or buprenorphine groups at both the observational checkpoints of 26-week and 52-week. Ultimately, from the findings of this study it can be concluded that the methadone treatment is more effective compared to alternatives <sup>9</sup>. | + | Moreover, studies have found the methadone maintenance treatment to be more effective compared to alternative treatments. In a controlled trial study that compared Buprenorphine and Methadone maintenance in treating opioid dependence, the findings suggested methadone to be more effective than buprenorphine <sup>10</sup>. A double-blinded study was conducted with two hundred twenty-five opioid addicts seeking treatment by placing them in one of three groups: 8 mg/d of buprenorphine, 30 mg/d of methadone, or 80 mg/d of methadone maintenance over a one-year timespan. Efficacy was measured by observing both objective and subjective outcomes at middle and end of the study period. These measures included urine toxicology, retention, craving, withdrawal symptoms, and safety data <sup>10</sup>. The results of the study suggest that the high dose methadone treatment showed significant improvements in retention, and opioid use and cravings, compared to both the low-dose methadone or buprenorphine groups at both the observational checkpoints of 26-week and 52-week. Ultimately, from the findings of this study it can be concluded that the methadone treatment is more effective compared to alternatives <sup>10</sup>. |
| - | Basically, lower doses of methadone may not be optimally effective or it may even result in the blockade effect. The blockade effect refers to the body’s ability to block the effect of any opiate drug used to treat opioid addiction through cross-tolerance. Essentially, according to multiple studies, the prevalence of illegal heroin usage is significantly higher in addicts receiving low doses of methadone compared to ones receiving higher doses <sup>15</sup>. | + | Basically, lower doses of methadone may not be optimally effective or it may even result in the blockade effect. The blockade effect refers to the body’s ability to block the effect of any opiate drug used to treat opioid addiction through cross-tolerance. Essentially, according to multiple studies, the prevalence of illegal heroin usage is significantly higher in addicts receiving low doses of methadone compared to ones receiving higher doses <sup>16</sup>. |
| === Cost Effectiveness === | === Cost Effectiveness === | ||
| - | The benefits of the methadone maintenance treatment overshadows the costs of administering, especially if the cost of untreated opioid abuse is considered. Ultimately, The cost of imprisonment, drug-free treatment programs,and neglected heroin dependence is significantly higher than that of the methadone maintenance treatment. Specifically, the social costs of illegal opioid usage is four times that of the methadone treatment <sup>19</sup>. With regards to cost benefits, Canada is beginning to observe the same trends as the United States-- for every dollar spent on methadone maintenance treatment, the community saves between four to thirteen dollars. Specifically, in Toronto, untreated opioid addictions results in an approximate annual cost of $44,600. Contrarily, the estimated cost to provide methadone maintenance treatment in Toronto is $6,00 per year. Ultimately, the methadone maintenance treatment is a cost-effective solution, considering its lower delivery cost and higher retention rates compared to other treatments for opioid addicts <sup>19</sup>. | + | The benefits of the methadone maintenance treatment overshadows the costs of administering, especially if the cost of untreated opioid abuse is considered. Ultimately, The cost of imprisonment, drug-free treatment programs,and neglected heroin dependence is significantly higher than that of the methadone maintenance treatment. Specifically, the social costs of illegal opioid usage is four times that of the methadone treatment <sup>15</sup>. With regards to cost benefits, Canada is beginning to observe the same trends as the United States-- for every dollar spent on methadone maintenance treatment, the community saves between four to thirteen dollars. Specifically, in Toronto, untreated opioid addictions results in an approximate annual cost of $44,600. Contrarily, the estimated cost to provide methadone maintenance treatment in Toronto is $6,00 per year. Ultimately, the methadone maintenance treatment is a cost-effective solution, considering its lower delivery cost and higher retention rates compared to other treatments for opioid addicts <sup>15</sup>. |
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| - | ====== Current Treatments ====== | + | ====== Methadone Program in Canada ====== |
| + | ====For Practitioners==== | ||
| + | In the past, practitioners were required to obtain an exemption from Health Canada before they could prescribe, sell, provide or administer methadone <sup>4</sup>. As of May 19, 2018, the Government of Canada removed this regulatory constraint and exemptions are no longer required from Health Canada for practitioners to prescribe, sell or administer methadone to their patients <sup>4</sup>. This change is meant to help Canadians have greater access to a comprehensive treatment options <sup>4</sup>. | ||
| - | Through research, it is clearly exemplified that anorexia nervosa is merely not an eating disorder but dives into deep-seeded issues an individual may have. The first step includes the acceptance of their disorder and familial assistance prepares individuals for the upcoming services. | + | ====For Pharmacists==== |
| - | A psychiatrist is beneficial for the prescription of medications including antidepressants as several individuals experience anxiety in accordance with the eating disorder (Kaye et. al 1999). Enlisting the services of a nutritionist will be of benefit as managing the fear of food will be adequately guided by a professional ensuring the appropriate quality and quantities of food are provided. | + | Pharmacists may sell or provide a narcotic to a person if the pharmacist has a written order or prescription, signed and dated, by a practitioner <sup>4</sup>. They no longer need to contact Health Canada in order to verify if a practitioner holds a valid exemption to prescribe methadone <sup>4</sup>. |
| + | ====For Patients==== | ||
| + | As of May 19,2018, patients can receive methadone if is is required for their condition and if they are administered under professional care <sup>4</sup>. They no longer need consent from Health Canada. | ||
| - | <box 70%| > {{ :anorexia_treatment.png?300 |}} </box| Figure 11: This image compiles a list of services an individual with anorexia nervosa may use to treat the condition. > | + | ====== Harm Reduction ====== |
| + | Harm reduction is essentially policies and strategies that are aimed at reducing negative consequences of active drug use <sup>12</sup>. Users no longer need to buy drugs from the black market, instead, they would visit the clinic several times each day to receive drugs supplied by the clinic under professional care <sup>12</sup>. The idea behind this is to respect the rights of people who use drugs, however, drug use is still punishable by law <sup>12</sup>. Many law enforcement agencies practice harm reduction policies in high drug use areas <sup>12</sup>. | ||
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| + | ====== Positive and Negative Implications ====== | ||
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| + | === Positive Effects === | ||
| + | There are many positive aspects of methadone clinics, this include giving the users the ability to stop using needles therefore, reducing the incidents of blood borne diseases like hepatitis C and HIV <sup>20</sup>. Moreover, clinics provide addicts with a structured treatment while ensuring that the quality of the drug is pure and the dosage is right since it comes directly from pharmaceutical companies instead of the street <sup>20</sup>. It also provides an opportunity for addicts to meet others with the same problem and intention to improve current condition, which allows for addicts to help and support each other <sup>20</sup>. | ||
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| + | A study conducted at Vancouver’s Crosstown Clinic found patients in the program cut back their use of drugs from at least 14 times a month to less than four times a month <sup>17</sup>. The study also found more than 80 per cent retention rate and 20 per cent have been able to graduate to less-intensive treatment options such as methadone pills after they stabilize <sup>17</sup>. | ||
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| + | === Negative Effects === | ||
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| + | One common observation amongst many different areas with high concentrations of people addicted to opiates and heroin is the prevalence of poverty. Services such as Methadone clinics are great additions in combating addiction, however, affordability is a crucial concept to consider. People in these general areas are often addicted to these substances due to circumstances that are out of their control (ie. hung out with the wrong crowd or hit with a sudden financial crisis). The stigma within these clinics is that while you can afford the treatment, you'll be treated very well, however, the moment it becomes affordable or you miss payments, the institution really stigmatizes you. They have the mentality of "if you can afford heroin, why can't you afford the treatment" <sup>21</sup>. This stigma coupled with the financial inaccessibility causes people to slowly shy off the treatment. As the dosages get smaller, the addiction often comes back to many people and it goes back to controlling their lives. It truly becomes a constant loop that can’t be broken and leaves people stuck in their unfortunate situation <sup>21</sup>. | ||
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| + | Another side effect that people often shrug off and do not take seriously is the fluctuations in weight gain that methadone users often experience. Many times, the dosage required to curb addiction is very variable and thus, quantities ingested are not always the correct amount. There has been a correlation between high methadone dosages and the increase in cravings that patients have in ingesting food that they deem rewarding <sup>8</sup>. Often times, this food is junk food and contains high amounts of sugar and fats. Essentially, this causes patients to substitute one addiction to another and this could lead to another severe problem such as diabetes. Counsellors have seen some patients gain up to 50 pounds in a mere 4 months of treatment, which puts peoples BMIs at levels exceeding 30 (overweight/obese) <sup>12</sup>. | ||
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| + | Lastly, the side effect that many individuals experienced was related to the functioning of their reproductive organs and their overall sexual experience as human. One mind boggling fact that isn't really advertised is that almost 40 percent of men over 40 will encounter some type of form of erectile dysfunction <sup>6</sup>. There are over 100 million individuals that fall into those categories and 40% would mean almost 40 million affected. This is quite the huge number of males affected. Luckily, only 12% of men are affected under 40, which is still quite a large number but dismal compared to the other statistic <sup>6</sup>. Some men have also reported decreased levels of libido, which is the desire to engage in sexual intercourse. Methadone also effects women's sexual drives as well by causing the loss of menstruation. Luckily, this only happens in a very small percentage of females <sup>6</sup>. | ||
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| - | The implementation of cognitive behavioural therapy will use psychotherapy as a means to address the underlying thoughts behind the condition. This will recognize those symptoms and assist in a healthy method of alleviating those notions (Kaye et al. 1999). Managing a long term eating disorder will be a difficult challenge however with the enlistment of these services, recovery will be possible. | ||
| ======Conclusion====== | ======Conclusion====== | ||
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| ===== References ===== | ===== References ===== | ||
| + | [1] Akbarali, H. I., & Dewey, W. L. (2017). The gut–brain interaction in opioid tolerance. Current Opinion in Pharmacology, 37, 126–130. https://doi.org/https://doi.org/10.1016/j.coph.2017.10.012 | ||
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| + | [2] Brownstein, M. J. (1993). A brief history of opiates, opioid peptides, and opioid receptors. Proceedings of the National Academy of Sciences of the United States of America, 90(12), 5391. | ||
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| + | [3] Chahl, A. Loris. (1996) Opioids - mechanisms of action. Australian Prescriber, 19(3), doi: 10.18773/austprescr.1996.063 | ||
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| + | [4] Connock, M., Juarez-Garcia, A., Jowett, S., Frew, E., Liu, Z., Taylor, R. J., ... & Burls, A. (2007). Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. | ||
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| + | [5] Government of Canada. (2017). Methadone Program. Retrieved from https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/exemptions/methadone-program.html | ||
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| + | [6] Hosseini, S. H., Isapour, A., Tavakoli, M., Taghipour, M., & Rasuli, M. (2013). Erectile dysfunction in methadone maintenance patients: a cross sectional study in northern Iran. Iranian journal of psychiatry, 8(4), 172. | ||
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| + | [7] Joseph, H., Stancliff, S., & Langrod, J. (2000). Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine, New York, 67(5-6), 347-364. | ||
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| + | [8] Kenny, P. J. (2013). The food addiction. Scientific American, 309(3), 44-49. | ||
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| + | [9] Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health, 36, 559-574. | ||
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| + | [10] Ling, W., Wesson, D. R., Charuvastra, C., & Klett, C. J. (1996). A controlled trial comparing buprenorphine and methadone maintenance in opioid dependence. Archives of general psychiatry, 53(5), 401-407. | ||
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| + | [11] Lucas, G. M., Mullen, B. A., Weidle, P. J., Hader, S., McCaul, M. E., & Moore, R. D. (2006). Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups. Clinical Infectious Diseases, 42(11), 1628-1635. | ||
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| + | [12] Marden, D. (2016). Western NC Harm Reduction: A Look Inside a Methadone Clinic. Retrieved from https://sobernation.com/western-nc-harm-reduction-a-look-inside/ | ||
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| + | [13] Marsch, L. A. (1998). The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta‐analysis. Addiction, 93(4), 515-532 | ||
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| + | [14] Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane database of systematic reviews, (3). | ||
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| + | [15] Methadone Treatment Effectiveness. (2018, September 18). Retrieved from https://www.oatc.ca/news-articles-information/methadone-treatment-effectiveness/ | ||
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| + | [16] Rettig, R. A., & Yarmolinsky, A. (1995). Pharmacology and Medical Aspects of Methadone Treatment. | ||
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| + | [17] Stolte, E. (2018). New opiod treatment clinic coming; core communities likely location. Retrieved from https://edmontonjournal.com/news/local-news/new-opioid-treatment-clinic-coming-core-communities-likely-location | ||
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| + | [18] Schaefer, C. P., Tome, M. E., & Davis, T. P. (2017). The opioid epidemic: a central role for the blood brain barrier in opioid analgesia and abuse. Fluids and barriers of the CNS, 14(1), 32. doi:10.1186/s12987-017-0080-3 | ||
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| + | [19] Thorp, R. H., Walton, E., & Ofner, P. (1947). Analgesic activity in compounds related to amidone. Nature, 159(4046), 679. | ||
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| + | [20] Towards recovery. (2017). Methadone treatment pros and cons. Retrieved from http://www.towardsrecovery.com/methadone-treatment-pros-cons/ | ||
| + | [21] Tran, B. X., Nguyen, L. H., Tran, T. T., & Latkin, C. A. (2018). Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients. PloS one, 13(1), e0190941. | ||
