Literature Collection

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.

Objectives: Physical health conditions cause significant disability and mortality among people living with alcohol and other drug problems. There has been limited research on the prevalence of health problems among clinical samples of people with substance use disorders, particularly among those in residential treatment. Yet residential settings provide unique opportunity for responding to health needs. To better understand the health of people attending treatment for substance use disorders, this study conducted a file review to examine the prevalence of physical health problems as identified during routine residential care. Methods: A retrospective review of client files collected between 2013 and 2017 (N = 172) was completed at a residential treatment service in NSW, Australia. Data were extracted to examine the prevalence of physical health problems recorded at entry into treatment. Correlates of health problems were estimated using bivariate descriptive analyses and logistic regression. Results: The majority of clients in treatment for substance use had a comorbid physical health problem (80.7%). Musculoskeletal problems were the most frequently reported medical issue (38.6%). Odds for some physical health problems were related to client gender, age, and primary substance of concern. Male gender remained the strongest predictor of dental health problems when controlling for age and substance type (odds ratio [OR] = 3.60). Primary alcohol use remained the strongest predictor of nutritional deficiencies when controlling for client age (OR = 4.43). Among clients with a physical health problem and who had a treatment episode of at least 14 days (n = 110), just over half (55.5%) were referred to a health-related practitioner or service during their treatment episode. Conclusions: This study contributes to the literature by reporting on the incidence of physical health problems among people in residential treatment for substance use disorders. The high prevalence of physical health morbidity iterates the role of non-medical staff working within drug and alcohol services in the identification of client health needs. The findings support calls for systematic screening of physical health as part of routine care for substance use disorders improved integration of substance treatment and the broader primary health care system.