Rx Methadone

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Methadone Dosing & Safety in the Treatment of Opioid Addiction
By Stewart B. Leavitt, PhD
(PDF file 312KB) Dosing and Safety WP.pdf

Adequate methadone dosing provides an effective response in the patient, with a margin for safety, for an appropriate duration of time. However, there is wide variation in patient response and dosing must be determined on an individual basis while exercising caution to avoid adverse effects. This 8-page, evidence-based White Paper discusses how methadone works, guidelines for proper dosing and safety, and the importance of patient education.

Cardiac Considerations During MMT
By Stewart B. Leavitt, PhD & Mori J. Krantz, MD, FACC
(PDF file 200KB) CardiacConsiderationsWhite Paper.pdf

Methadone Maintenance Treatment in the Criminal Justice System
by Stewart B. Leavitt, Ph.D. (PDF file 1,364KB) Justice WP.pdf

The merits and effectiveness of addiction treatment in the criminal justice system and methadone maintenance treatment (MMT) for opioid addiction, in particular, have not been universally understood and accepted. However, criminal justice populations are in critical need of treatment for opioid addiction and most still do not have access to it. This paper focuses on well-established evidence and credible commentary to provide a current and balanced perspective on MMT within court, jail, and prison settings.

A Community-Centered Solution for Opioid Addiction -
Methadone Maintenance Treatment (MMT)
by Stewart B. Leavitt, Ph.D. (PDF file 2200KB) Community_WP.pdf

Some patients entering methadone maintenance treatment (MMT) may have conditions or behaviors associated with increased risks of arrhythmia. This 6-page White Paper summarizes research evidence concerning methadone effects on heart health. Clinical suggestions are offered for identifying individual patient cardiac-risk factors and for optimizing cardiac safety during MMT.

SAM in MMT* (*Substance-Abuse Monitoring in Methadone Maintenance Treatment).
A 12-page, evidence-based AT Forum White Paper discussing how drug screening and testing can be vital therapeutic tools supporting rehabilitation and recovery from opioid addiction. Released in April 2005.
(PDF file 356KB) SAM in MMT - FINAL April 2005.pdf

SAM in MMT - SUPPLEMENT
A companion to the SAM in MMT paper (above) providing supplemental technical information and tables, including: 1) Terms defining drug screen/test performance; 2) Understanding cutoff values of drug screens; 3) Cutoff levels, detection times, X-reactivity; 4) How typical on-site drug screening devices work. Released in July 2005.
(PDF file 467KB) SAM in MMT - SUPPLEMENT.pdf

Methadone-Drug* Interactions
(*Medications, illicit drugs, & other substances)
3rd Edition – November 2005 – Revision/Update
By Stewart B. Leavitt, PhD

This extensive document is only available via download in PDF format at: http://www.atforum.com/SiteRoot/pages/addiction_resources/Drug_Interactions.pdf
(file size 660KB).
Requires Acrobat® Reader®, which can be downloaded free from Adobe at http://www.adobe.com or click the icon on the right…

Each year in the U.S. there are innumerable adverse drug reactions, broadly defined as any unexpected, unintended, undesired, or excessive response to a medicine. Such reactions may require discontinuing or changing medication therapy. Furthermore, greater than 2 million of those are serious reactions resulting in hospitalization and/or permanent disability, and there are more than 100,000 deaths annually attributed to reactions involving prescribed medications.

Three-fourths of those adverse reactions relate to drug interactions, which occur when the amount or action of a drug in the body is altered – usually increased or decreased – by the presence of another drug or multiple drugs. Avoiding these can be difficult and, as the tables in this document indicate, there are more than100 substances – medications, illicit drugs, OTC products, etc. – that can interact in some fashion to affect a patient’s response to methadone.

During clinical use in the maintenance treatment of opioid addiction, spanning more than 40 years, oral methadone has proven to be a well-tolerated medication with minimal adverse reactions when prescribed in appropriate doses and taken daily as a component of MMT. However, potential methadone-drug interactions sometimes can be difficult to predict. Such interactions may be potentially harmful and/or can lead to treatment failures; although, they can usually be avoided or minimized.

Section Contents

	Understanding Methadone Metabolism & Drug Interactions The Importance of Drug Interactions Metabolic Basics Methadone Metabolism Methadone-Drug Interactions Putting Concepts Into Practice
	Table Abbreviations, Data Sources, & Notes
	Table 1: Drugs That Are CONTRAINDICATED with Methadone (May Precipitate Opioid Withdrawal)
	Table 2: Drugs That May Result in Altered Metabolism or Unpredictable Interactions with Methadone
	Table 3: Drugs That May LOWER Serum Methadone Level (SML) and/or DECREASE Methadone Effects
	Table 4: Drugs That May RAISE Serum Methadone Level (SML) and/or INCREASE Methadone Effects
	Table 5: Methadone-Drug Interactions: Alphabetical Listing by Generic & Brand Names
	Table 6: Drug Interactions Resources on the Internet
	References