Tuesday, January 23, 2007

MAINTENANCE VS. DETOX EMPHASIS WITH METHADONE AND BUPRENORPHINE:

According to Drug and Alcohol Services Information System (DASIS, Office of Applied Studies, SAMHSA), publication issue 36 (2006), and information received from DASIS directly, "clients" receiving methadone on 31 March 2005 were enrolled in opioid treatment programs self-identified as follows: 95,058 in maintenance programs, 2,131 in detoxification programs and 138,647 in programs offering services with both goals. In percentage terms, 59% were in programs pursuing both goals, and of the remaining 41% whose programs had one therapeutic goal or the other, only 2% were in detoxification programs.

The corresponding information for buprenorphine recipients was as follows: 288 were in maintenance programs, 112 in detoxification services and 765 (66% of the total) were in programs offering both. Of the 34% in programs with one or the other defined goal, 28% were being detoxified.

Unfortunately, DASIS states it has no information on any office-based (non-"program") providers or patients, and has no way of breaking down maintenance vs. detoxification recipients in programs offering both services. However, it is striking that for those individuals enrolled in programs with defined goals, 14 times as many buprenorphine recipients were in detoxification compared to those who received methadone.

Sure, there are lots of unknowns here, but the data obviously are considered meaningful enough to be collected, analysed and reported to the public. So . . . what do these strikingly different proportions of maintenance vs. detoxification mean, and is there any evidence in the world-wide literature that would support such a disparity?

Comments welcomed.

6 Comments:

At 9:55 AM, Blogger J.R. said...

I'll bet it's the same thing that methadone went through some decades ago. At that time nearly all patients were put through short-term methadone deoxifications from heroin addiction. They nearly all relapsed and this was done away with, saving addicts much pain and destruction to quality of life. It seems from these data that bup patients are being forced to run this same gauntlet. Long term opiate addiction produces permanent damage to the addict for which methadone is a treatment. Why would not the same be true for these bup patients?? The shame is the high price being paid by these addicts to find that answer.
J.R. Neuberger
NAMA Delaware

 
At 12:55 PM, Blogger RGNewman, MD said...

Hello NAMA Delaware - not sure about the ref to od days with methadone detox vs. maintenance. I believe there were always many many heroin users who preferred short-term non-judgmental detox and put off the issue of long-term treatment (methaone or other). Butn in any event, your bottom line is absolutely right on target: most of the public just can't accepot the reality that opiate addiciton is a chronic relapsing treatable-but-incurable condition. I just don't see any comments by govt or prof societies or others indicating that detox is fine if that's what the pt wants, but dead wrong if it's given under the illusion that this will result in permanent abstinence for more than a small segment of the patients. rn

 
At 11:39 PM, Blogger Stellathomas said...

Succinate in the body wall tissue was low as long as no sulfide appeared in the coelomic fluid, indicating the maintenance of an aerobic metabolism. The oxidation of sulfide to thiosulfate was localized in the mitochondria of the body wall tissue. The oxygen consumption of mitochondria was stimulated by the addition of sulfide. The mitochondrial sulfide oxidation rate depended on the amount of mitochondrial protein and followed a Michaelis-Menten kinetic.
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Stellathomas


Drug Detox

 
At 5:42 AM, Blogger Jolly said...

HI,

Thanks for writing such a good article.

Thanks for writing such a great article. It’s really good to know about drug rehab in such a detail. It all begins with the idea to try how it feels when you take a sip of alcohol. It was not only depends a mouthful, so that increases the desire of some of the drink. And that is how we become dependent, and soon will need Alcohol Detox and rehabilitation.

Thanks,

 
At 2:51 PM, Blogger Mike Bishop7 said...

Thank you for sharing this article. I have a family member going through Methadone Detox, so I have been online trying to educate myself more on the subject and on the subject of addiction as a whole. Reading your article has helped greatly. I hope this has changed since this article has been posted because if what J.R. has said it's true this is not a good thing. Thank you again for sharing.

 
At 2:37 AM, Blogger charles jeam said...

During the alcohol detoxification program one has to withdraw from the usage of the same so that all the toxins which have alcohol as their base are expelled from the body. Alcohol detox

 

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