An overview on medication-assisted treatment (MAT) for opioid dependence

Tanay Maiti, DPM, DNB; Saibal Das, MD; Anand Ramasamy, MPharm; Alphienes Stanley Xavier, MD, DM, DNB; Sapan Kumar Behera, MD, DM; Sandhiya Selvarajan, MD, DM, DNB

doi:10.5055/jom.2020.0560

Authors

Tanay Maiti, DPM, DNB
Saibal Das, MD
Anand Ramasamy, MPharm
Alphienes Stanley Xavier, MD, DM, DNB
Sapan Kumar Behera, MD, DM
Sandhiya Selvarajan, MD, DM, DNB

DOI:

https://doi.org/10.5055/jom.2020.0560

Keywords:

buprenorphine, dependence, drugs, methadone, opioid

Abstract

In this article, a broad overview of medication-assisted treatment (MAT) for opioid dependence has been provided. Significant benefits of commonly used drugs (buprenorphine, methadone, and naltrexone-based regimens) along with the therapeutic aspects of other available options are highlighted. Salient points on each or individual drug therapy, comparison of pharmacological profiles of different drugs, effective clinical practice in different scenarios, relevant drug interactions, and safety issues in various populations have been emphasized. Finally, special issues, such as cost-effectiveness of different medication regimens, community-based approach, dealing with a special population, and upcoming new treatment modalities of MAT have been discussed.

Author Biographies

Tanay Maiti, DPM, DNB

Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, India

Saibal Das, MD

Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Anand Ramasamy, MPharm

Department of Pharmacology, MDA School of Pharmacy, Latur, India

Alphienes Stanley Xavier, MD, DM, DNB

Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, India

Sapan Kumar Behera, MD, DM

Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Sandhiya Selvarajan, MD, DM, DNB

Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

References

UNODC: Executive Summary. 2018. Available at https://www.unodc.org/wdr2017/field/Booklet_1_EXSUM.pdf. Accessed May 14, 2019.

Brunton L, Hilal-Dandan R, Knollmann B: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill Education; 355-386.

American Psychiatric Association: 2018. Available at https://www.psychiatry.org/psychiatrists/education/signature-initiatives/model-curriculum-project-for-substance-use-disorders/medication-assisted-treatment-for-opioid-use-disorder. Accessed May 15, 2019.

U.S. Food and Drug Administration: Research C for DE and Information by Drug Class--FDA Opioids Action Plan. 2018. Available at https://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm484714.htm. Accessed May 14, 2019.

Dole VP: Implications of methadone maintenance for theories of narcotic addiction. JAMA. 1988; 260(20): 3025-3029.

Linares OA, Fudin J, Daly A, et al.: Methadone recycling sustains drug reservoir in tissue. J Pain Palliat Care Pharmacother. 2015; 29(3): 261-271.

Rettig RA, Yarmolinsky A: Treatment I of M (US) C on FR of M, Pharmacology and Medical Aspects of Methadone Treatment. National Academies Press (US), 1995. Available at https://www.ncbi.nlm.nih.gov/books/NBK232112/. Accessed May 15, 2019.

Dole VP, Kreek MJ: Methadone plasma level: sustained by a reservoir of drug in tissue. Proc Natl Acad Sci USA. 1973; 70(1): 10.

ASAM: 2018. Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs. Available at https://www.asam.org/docs/advocacy/samhsa_tip43_matforopioidaddiction.pdf?sfvrsn=0. Accessed May 10, 2019.

Stotts AL, Dodrill CL, Kosten TR: Opioid dependence treatment: options in pharmacotherapy. Expert Opin Pharmacother. 2009; 10(11): 1727-40.

Kleber HD: Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci. 2007; 9(4): 455-470.

Ling W, Wesson DR, Charuvastra C: A controlled trial comparing buprenorphine and methadone maintenance in opioid dependence. Arch Gen Psychiatry. 1996; 53(5): 401-407.

Johnson RE, Chutuape MA, Strain EC, et al.: A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med. 2000; 343(18): 1290-1297.

Mattick RP, Kimber J, Breen C, et al.: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004; (3): CD002207. DOI: 10.1002/14651858.CD002207.pub2.

Simpson DD, Joe GW, Rowan-Szal GA: Drug abuse treatment retention and process effects on follow-up outcomes. Drug Alcohol Depend. 1997; 47(3): 227-235.

Hartel DM, Schoenbaum EE: Methadone treatment protects against HIV infection: Two decades of experience in the Bronx, New York: Public Health Rep. 1998; 113(Suppl. 1): 107-115.

Kakko J, Grönbladh L, Svanborg KD, et al.: A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence: A randomized controlled trial. Am J Psychiatry. 2007; 164(5): 797-803.

Nicholls L, Bragaw L, Ruetsch C: Opioid dependence treatment and guidelines. J Manag Care Pharm JMCP. 2010; 16(1 Suppl B): S14-S21.

SAMHSA: Substance Abuse and Mental Health Services Administration. 2018. Available at https://www.samhsa.gov/. Accessed May 10, 2019.

Schuckit MA: Treatment of Opioid-Use Disorders. N Engl J Med. 2016; 375(4): 357-368.

Jarvis MA, Schnoll SH: Methadone treatment during pregnancy. J Psychoactive Drugs. 1994; 26(2): 155-161.

Jansson LM, Dipietro J, Elko A: Fetal response to maternal methadone administration. Am J Obstet Gynecol. 2005; 193(3 Pt 1): 611-617.

Jarvis MA, Wu-Pong S, Kniseley JS: Alterations in methadone metabolism during late pregnancy. J Addict Dis. 1999; 18(4): 51-61.

Pond SM, Kreek MJ, Tong TG, et al.: Altered methadone pharmacokinetics in methadone-maintained pregnant women. J Pharmacol Exp Ther. 1985; 233(1): 1-6.

Hoegerman G, Schnoll S: Narcotic use in pregnancy. Clin Perinatol. 1991; 18(1): 51-76.

Wittmann BK, Segal S: A comparison of the effects of single- and split-dose methadone administration on the fetus: Ultrasound evaluation. Int J Addict. 1991; 26(2): 213-218.

Johnson RE, Jones HE, Jasinski DR, et al.: Buprenorphine treatment of pregnant opioid--dependent women: maternal and neonatal outcomes. Drug Alcohol Depend. 2001; 63(1): 97-103.

Schindler SD, Eder H, Ortner R, et al.: Neonatal outcome following buprenorphine maintenance during conception and throughout pregnancy. Addict Abingdon Engl. 2003; 98(1): 103-110.

McCance-Katz EF, Sullivan L, Nallani S: Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: A review. Am J Addict. 2010; 19(1): 4-16.

Kosten TR, Rounsaville BJ, Kleber HD: A 2.5-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry. 1986; 43(8): 733-738.

Iribarne C, Picart D, Dréano Y, et al.: In vitro interactions between fluoxetine or fluvoxamine and methadone or buprenorphine. Fundam Clin Pharmacol. 1998; 12(2): 194-199.

Bertschy G, Baumann P, Eap CB, et al.: Probable metabolic interaction between methadone and fluvoxamine in addict patients. Ther Drug Monit. 1994; 16(1): 42-45.

Baumann P: Pharmacokinetic-pharmacodynamic relationship of the selective serotonin reuptake inhibitors. Clin Pharmacokinet. 1996; 31(6): 444-469.

Hamilton SP, Nunes EV, Janal M, et al.: The effect of sertraline on methadone plasma levels in methadone-maintenance patients. Am J Addict. 2000; 9(1): 63-69.

Lintzeris N, Mitchell TB, Bond A, et al.: Interactions on mixing diazepam with methadone or buprenorphine in maintenance patients. J Clin Psychopharmacol. 2006; 26(3): 274-283.

Lintzeris N, Mitchell TB, Bond AJ, et al.: Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high dose conditions in opioid dependent patients. Drug Alcohol Depend. 2007; 91(2-3): 187-194.

Rogers WO, Hall MA, Brissie RM, et al.: Detection of alprazolam in three cases of methadone/benzodiazepine overdose. J Forensic Sci. 1997; 42(1): 155-156.

Uehlinger C, Crettol S, Chassot P, et al.: Increased (R)-methadone plasma concentrations by quetiapine in cytochrome P450s and ABCB1 genotyped patients. J Clin Psychopharmacol. 2007; 27(3): 273-278.

Lopez P, Velez R, Rivera V, et al.: Characteristics of P-glycoprotein (Pgp) upregulated in chronic cocaine users and HIV infected persons. Retrovirology. 2005; 2(1): P142.

McCance-Katz EF, Rainey PM, Moody DE: Effect of cocaine use on buprenorphine pharmacokinetics in humans. Am J Addict. 2010; 19(1): 38-46.

Kreek MJ: Metabolic interactions between opiates and alcohol. Ann N Y Acad Sci. 1981; 362: 36-49.

Schwartz EL, Brechbūhl AB, Kahl P, et al.: Pharmacokinetic interactions of zidovudine and methadone in intravenous drug-using patients with HIV infection. J Acquir Immune Defic Syndr. 1992; 5(6): 619-626.

Rainey PM, Friedland G, McCance-Katz EF, et al.: Interaction of methadone with didanosine and stavudine. J Acquir Immune Defic Syndr. 2000; 24(3): 241-248.

Kreek MJ, Garfield JW, Gutjahr CL, et al.: Rifampin-induced methadone withdrawal. N Engl J Med. 1976; 294(20): 1104-1106.

Cao X, Wu Z, Li L, et al.: Mortality among methadone maintenance clients in China: a six-year cohort study. PloS One. 2013; 8(12): e82476.

Hickman M, Vickerman P, Degenhardt L: Editorial commentary: The impact of opiate substitution therapy and highly active antiretroviral therapy on mortality risk among people who inject drugs. Clin Infect Dis Off Publ Infect Dis Soc Am. 2015; 61(7): 1166-1168.

Liu E, Rou K, McGoogan JM, et al.: Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China. J Infect Dis. 2013; 208(3): 442-453.

Edelman EJ, Fiellin LE: Opioid substitution therapy is associated with decreased HIV transmission among people who inject drugs. Evid Based Med. 2013; 18(5): 177-178.

Rao R: The journey of opioid substitution therapy in India: Achievements and challenges. Indian J Psychiatry. 2017; 59(1): 39-45.

Dennis BB, Naji L, Bawor M, et al.: The effectiveness of opioid substitution treatments for patients with opioid dependence: A systematic review and multiple treatment comparison protocol. Syst Rev. 2014; 3: 105.

Wedam EF, Bigelow GE, Johnson RE, et al.: QT-interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med. 2007; 167(22): 2469-2475.

de Jong IM, de Ruiter GS: Buprenorphine as a safe alternative to methadone in a patient with acquired long QT syndrome: A case report. Neth Heart J Mon J Neth Soc Cardiol Neth Heart Found. 2013; 21(5): 249-252.

Goldschmidt PG: A cost-effectiveness model for evaluating health care programs: application to drug abuse treatment. Inq J Med Care Organ Provis Financ. 1976; 13(1): 29-47.

Doran CM, Shanahan M, Mattick RP, et al.: Buprenorphine versus methadone maintenance: A cost-effectiveness analysis. Drug Alcohol Depend. 2003; 71(3): 295-302.

Ettner SL, Huang D, Evans E, et al.: Benefit-cost in the California treatment outcome project: Does substance abuse treatment "pay for itself?" Health Serv Res. 2006; 41(1): 192-213.

Jones ES, Moore BA, Sindelar JL, et al.: Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients. Drug Alcohol Depend. 2009; 99(1-3): 132-140.

Chou R, Korthuis PT, Weimer M, et al.: Agency for Healthcare Research and Quality (US), 2016. Available at https://www.ncbi.nlm.nih.gov/books/NBK402343/. Accessed May 15, 2019.

United Nations Office on Drugs and Crime: 2018. International Standards for the Treatment of Drug Use Disorders. Available at https://www.who.int/substance_abuse/activities/msb_treatment_standards.pdf. Accessed May 10, 2019.

Mintzer IL, Eisenberg M, Terra M, et al.: Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Fam Med. 2007; 5(2): 146-150.

Simoens S, Matheson C, Bond C, et al.: The effectiveness of community maintenance with methadone or buprenorphine for treating opiate dependence. Br J Gen Pract. 2005; 55(511): 139-46.

Frei M: Party drugs--Use and harm reduction. Aust Fam Physician. 2010; 39(8): 548-552.

Bammer G, van den Brink W, Gschwend P, et al.: What can the Swiss and Dutch trials tell us about the potential risks associated with heroin prescribing? Drug Alcohol Rev. 2003; 22(3): 363-371.

Sheldon T: Netherlands considers prescribing heroin to addicts. BMJ. 2002; 324(7334): 385.

Rehm J, Gschwend P, Steffen T, et al.: Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: A follow-up study. Lancet Lond Engl. 2001; 358(9291): 1417-1423.

Barnwal P, Das S, Mondal S, et al.: Probuphine® (buprenorphine implant): a promising candidate in opioid dependence. Ther Adv Psychopharmacol. 2017; 7(3): 119-134.

Montoya ID, Vocci F: Novel medications to treat addictive disorders. Curr Psychiatry Rep. 2008; 10(5): 392-398.

Walsh SL, Strain EC, Bigelow GE: Evaluation of the effects of lofexidine and clonidine on naloxone-precipitated withdrawal in opioid-dependent humans. Addict Abingdon Engl. 2003; 98(4): 427-439.

Herman BH, Vocci F, Bridge P: The effects of NMDA receptor antagonists and nitric oxide synthase inhibitors on opioid tolerance and withdrawal. Medication development issues for opiate addiction. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 1995; 13(4): 269-293.

Comer SD, Sullivan MA: Memantine produces modest reductions in heroin-induced subjective responses in human research volunteers. Psychopharmacology. (Berl). 2007; 193(2): 235-245.

Parsons D, Burrows D, Bolotbaeva A: Advocating for opioid substitution therapy in Central Asia: much still to be done. Int J Drug Policy. 2014; 25(6): 1174-1177.