Craving is Related to Persisting Heroin Use among Patients in Methadone Maintenance Treatment

藥物渴求與美沙酮治療病人持續使用海洛因之關聯性

楊筌棋(Chuan-Chi Yang)；楊斯年(Szu-Nian Yang)；陳淵渝(Yuan-Yu Chan)

methadone ； craving ； risk factor ； heroin dependency

台灣精神醫學

30卷4期（2016 / 12 / 01）

311 - 317

英文

Objective: Methadone maintenance treatment (MMT) is recognized as an effective treatment in patients with opiate use disorder. But its effect is compromised due to the high incidence of relapse to use heroin. In this study, we intended to investigate factors related to illicit opioid use in MMT patients. Methods: In 90 MMT patients, we collected information of demographic data, opioid urine screen results, heroin and amphetamine abuse history, daily methadone dose, heroin craving visual analogue scale (VAS), Beck Anxiety Inventory score, Beck Depression Inventory II score, and Pittsburgh Sleep Quality Index (PSQI) score. We tested the difference between groups. Results: Of 90 MMT patients, 48 of them (53.3%) were found to have positive opioid urine. Variables such as age, gender, severity of anxiety and depression, sleep quality, and daily methadone dosages were not found to be significantly related to patients' positive opioid urine. A significant difference existed in the heroin craving scores between patients with positive opioid urine and those with negative opioid urine group (37.94 ± 33.98 vs. 20.07 ± 25.78, p ＜ 0.01). But patients with higher level of heroin craving were more to have illicit opioid use. Conclusion: Heroin craving was associated with persistent heroin use among our MMT patients. Further studies are needed to clarify the complex relationships between the multidimensional nature of craving and severity of heroin dependency or mental distress to develop optimal treatment strategies.

1. American Psychiatric Association(2013).Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition (DSM-5).Arlington, Virginia, USA:American Psychiatric Association.
2. Astals, M,Díaz, L,Domingo-Salvany, A(2009).Impact of co-occurring psychiatric disorders on retention in a methadone maintenance program: an 18-month follow-up study.Int J Environ Res Public Health,6,2822-2832.
3. Barry, DT,Beitel, M,Garnet, B(2009).Relations among psychopathology, substance use, and physical pain experiences in methadone-maintained patients.J Clin Psychiatry,70,1213-1218.
4. Bell, J,Chan, J,Kuk, A(1995).Investigating the influence of treatment philosophy on outcome of methadone maintenance.Addiction,90,823-830.
5. Brands, B,Blake, J,Sproule, B(2004).Prescription opioid abuse in patients presenting for methadone maintenance treatment.Drug Alcohol Depend,73,199-207.
6. Butler, B,Rubin, G,Lawrance, A(2011).Estimating the risk of fatal arrhythmia in patients in methadone maintenance treatment for heroin addiction.Drug Alcohol Rev,30,173-180.
7. Buysse, DJ,Reynolds, CF,Monk, TH(1989).The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatry Res,28,193-213.
8. Cao, X,Wu, Z,Li, L(2013).Mortality among methadone maintenance clients in China: a six-year cohort study.PLoS One,8,e82476.
9. Chan, YY,Chen, YH,Yang, SN(2015).Clinical efficacy of traditional Chinese medicine, suan zao ren tang, for sleep disturbance during methadone maintenance: a randomized, double-blind, placebo-controlled trial.Evid Based Complement Alternat Med,2015,710895.
10. Chan, YY,Yang, SN,Lin, JC(2015).Inflammatory response in heroin addicts undergoing methadone maintenance treatment.Psychiatry Res,226,230-234.
11. Chen, YZ,Huang, WL,Shan, JC(2013).Self-reported psychopathology and health-related quality of life in heroin users treated with methadone.Neuropsychiatr Dis Treat,9,41-48.
12. Davstad, I,Stenbacka, M,Leifman, A(2007).Patterns of illicit drug use and retention in a methadone program: a longitudinal study.J Opioid Manag,3,27-34.
13. Fareed, A,Vayalapalli, S,Casarella, J(2010).Heroin anticraving medications: a systematic review.Am J Drug Alcohol Abuse,36,332-341.
14. Fareed, A,Vayalapalli, S,Stout, S(2011).Effect of methadone maintenance treatment on heroin craving, a literature review.J Addict Dis,30,27-38.
15. Fulton, HG,Barrett, SP,MacIsaac, C(2011).The relationship between self-reported substance use and psychiatric symptoms in low-threshold methadone maintenance treatment clients.Harm Reduct J,8,1.
16. Gelkopf, M,Weizman, T,Melamed, Y(2006).Does psychiatric comorbidity affect drug abuse treatment outcome? a prospective assessment of drug abuse, treatment tenure and infectious diseases in an Israeli methadone maintenance clinic.Isr J Psychiatry Relat Sci,43,126.
17. Grant, B,Stinson, F,Dawson, D(2005).Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on alcohol and related conditions.Alcohol Res Health,29,107.
18. Joseph, H,Stancliff, S,Langrod, J(1999).Methadone maintenance treatment (MMT): a review of historical and clinical issues.Mt Sinai J Med,67,347-364.
19. Jovanović, T,Lazarević, D,Nikolić, G(2012).Differences in depression severity and frequency of relapses in opiate addicts treated with methadone or opiate blocker after detoxification.Vojnosanit Pregl,69,326-332.
20. Kosten, TR,Schottenfeld, R,Ziedonis, D(1993).Buprenorphine versus methadone maintenance for opioid dependence.J Nerv Ment Dis,181,358-364.
21. Liao, DL,Chen, PC,Chen, CH(2013).Higher metha-done doses are associated with lower mortality in patients of opioid dependence in Taiwan.J Psychiatr Res,47,1530-1534.
22. Lions, C,Carrieri, MP,Michel, L(2014).Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial).Drug Alcohol Depend,135,1-8.
23. Maddux, JF,Prihoda, TJ,Vogtsberger, KN(1997).The relationship of methadone dose and other variables to outcomes of methadone maintenance.Am J Addict,6,246-255.
24. Naji, L,Dennis, BB,Bawor, M(2016).A prospective study to investigate predictors of relapse among patients with opioid use disorder treated with methadone.Subst Abuse,10,9.
25. O’Brien, CP(2005).Anticraving medications for relapse prevention: a possible new class of psychoactive medications.Am J Psychiatry,162,1423-1431.
26. Preston, KL,Umbricht, A,Epstein, DH(2000).Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance.Arch Gen Psychiatry,57,395-404.
27. Regier, DA,Farmer, ME,Rae, DS(1990).Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study.JAMA,264,2511-2518.
28. Sanford, SD,Bush, AJ,Stone, KC(2008).Psychometric evaluation of the Beck Anxiety Inventory: a sample with sleep-disordered breathing.Behav Sleep Med,6,193-205.
29. Schottenfeld, RS,Pakes, JR,Kosten, TR(1998).Prognostic factors in Buprenorphine- versus methadone-maintained patients.J Nerv Ment Dis,186,35-43.
30. Segal, DL,Coolidge, FL,Cahill, BS(2008).Psychometric properties of the Beck Depression Inventory–II (BDI-II) among community-dwelling older adults.Behav Modif,32,3-20.
31. Senbanjo, R,Wolff, K,Marshall, E(2009).Persistence of heroin use despite methadone treatment: poor coping self-efficacy predicts continued heroin use.Drug Alcohol Rev,28,608-615.
32. Soyka, M,Zingg, C,Koller, G(2008).Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study.Int J Neuropsychopharmacol,11,641-653.
33. Strain, EC,Bigelow, GE,Liebson, IA(1999).Moderate-vs. high-dose methadone in the treatment of opioid dependence: a randomized trial.JAMA,281,1000-1005.
34. Tiffany, ST,Friedman, L,Greenfield, SF(2012).Beyond drug use: a systematic consideration of other outcomes in evaluations of treatments for substance use disorders.Addiction,107,709-718.
35. Tiffany, ST,Wray, JM(2012).The clinical significance of drug craving.Ann N Y Acad Sci,1248,1-17.
36. Tsai, PS,Wang, SY,Wang, MY(2005).Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects.Qual Life Res,14,1943-1952.
37. Wang, Y,Wang, H,Li, W(2014).Reduced responses to heroin-cue-induced craving in the dorsal striatum: effects of long-term methadone maintenance treatment.Neurosci Lett,581,120-124.
38. White, WL,Campbell, MD,Spencer, RD(2014).Patterns of abstinence or continued drug use among methadone maintenance patients and their relation to treatment retention.J Psychoactive Drugs,46,114-122.
39. Yen, CF,Lin, HC,Wang, PW(2016).Heroin craving and its correlations with clinical outcome indicators in people with heroin dependence receiving methadone maintenance treatment.Compr Psychiatry,65,50-56.
40. Yin, W,Pang, L,Cao, X(2015).Factors associated with depression and anxiety among patients attending community-based methadone maintenance treatment in China.Addiction,110,51-60.

1. (2024).Experience of Patients With Heroin Addiction Receiving Methadone Maintenance Treatment in Community Settings in Taiwan.The Journal of Nursing Research,32(4),1-7.