TY - JOUR
KW - Animals
KW - Cohort Studies
KW - Female
KW - Humans
KW - Methadone/adverse effects
KW - Middle Aged
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy
KW - Prospective Studies
KW - Swine
KW - adverse effects
KW - methadone maintenance treatment
KW - opioid agonist treatment
KW - Serum concentrations
KW - Subjective opioid withdrawal symptoms
KW - substance use
AU - F. Chalabianloo
AU - L. T. Fadnes
AU - G. Høiseth
AU - C. Ohldieck
AU - J. H. Vold
AU - C. Aas
AU - E. M. Løberg
AU - K. A. Johansson
AU - J. G. Bramness
A1 - 
AB - BACKGROUND: There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments. METHODS: This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms using 16 items Subjective Opioid Withdrawal Scale (SOWS) questionnaire, self-reported adverse effects, and substance use was obtained. Linear mixed modelling was used for analyzing the data. RESULTS: The mean age of the participants was 45 years, and 33% were women. Almost half reported mild to moderate subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. The use of at least one substance was reported by 88% of the participants. Serum concentration-to-dose ratios were lower among those who had reported subjective opioid withdrawal symptoms (p) = 0.039). The total SOWS score (p < 0.001); the specific subjective withdrawal symptoms of anxiety (p = 0.004), bone and muscle aches (p = 0.003), restlessness (p = 0.017), and (slightly) shaking (p = 0.046), also use of heroin (p = 0.015) and alcohol (p = 0.011) were associated with lower methadone concentrations. Cannabis use was slightly related to higher methadone concentrations (p = 0.049). CONCLUSIONS: The findings suggest that the patient's self-perceived symptoms and current clinical condition are related to the serum concentrations of methadone. This interpretation supports dose adjustments based on patient-reported symptoms. In some aberrant cases, measurement of serum concentrations together with other individual assessments may be considered to support the clinical decision.
AD - Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. fatemeh.chalabianloo@helse-bergen.no.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. fatemeh.chalabianloo@helse-bergen.no.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway.; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.; Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Institute of Clinical Psychology, University of Bergen, Bergen, Norway.; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.; Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.
BT - Substance abuse treatment, prevention, and policy
C5 - Measures; Opioids & Substance Use
CP - 1
DO - 10.1186/s13011-021-00367-w
IS - 1
JF - Substance abuse treatment, prevention, and policy
LA - eng
M1 - Journal Article
N2 - BACKGROUND: There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments. METHODS: This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms using 16 items Subjective Opioid Withdrawal Scale (SOWS) questionnaire, self-reported adverse effects, and substance use was obtained. Linear mixed modelling was used for analyzing the data. RESULTS: The mean age of the participants was 45 years, and 33% were women. Almost half reported mild to moderate subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. The use of at least one substance was reported by 88% of the participants. Serum concentration-to-dose ratios were lower among those who had reported subjective opioid withdrawal symptoms (p) = 0.039). The total SOWS score (p < 0.001); the specific subjective withdrawal symptoms of anxiety (p = 0.004), bone and muscle aches (p = 0.003), restlessness (p = 0.017), and (slightly) shaking (p = 0.046), also use of heroin (p = 0.015) and alcohol (p = 0.011) were associated with lower methadone concentrations. Cannabis use was slightly related to higher methadone concentrations (p = 0.049). CONCLUSIONS: The findings suggest that the patient's self-perceived symptoms and current clinical condition are related to the serum concentrations of methadone. This interpretation supports dose adjustments based on patient-reported symptoms. In some aberrant cases, measurement of serum concentrations together with other individual assessments may be considered to support the clinical decision.
PY - 2021
SN - 1747-597X; 1747-597X
SP - 39
T1 - Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway
T2 - Substance abuse treatment, prevention, and policy
TI - Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway
U1 - Measures; Opioids & Substance Use
U2 - 33941217
U3 - 10.1186/s13011-021-00367-w
VL - 16
VO - 1747-597X; 1747-597X
Y1 - 2021
Y2 - May 3
ER -