Managing Alcohol Use Disorders in OTP [methadone maintenance] Patients"
Policies regarding "managing alcohol use disorders in OTP [methadone maintenance] patients" is the lead story in current Addiction Treatment Forum (vol. 20, no. 2, spring 2010). An example is cited: "A patient arrives [at the methadone clinic] obviously inebriated, but docile. Some OTPs send the patient home in a taxi without dosing. Others keep the patient in the waiting room until breathalyzer scores are low enough for at least a partial dose ... "Question is: is there a basis for either practice? Any evidence that a constant daily dose of methadone to which, by definition, the patient is presumed to be tolerant), would be risky if the patient is intoxicated - and/or the breathalyzer "score" is above a certain threshold? And if there is basis for considering usual - or reduced - dose of methadone to be risky, how does the danger compare to that which might be expected if the patient resorts to illicit opiates to prevent or treat withdrawal symptoms before the methadone is available from the clinic the next day? Comments (and references) welcomed!
posted by RGNewman, MD @ 9:59 AM
2 comments
2 Comments:
Existe una clase de interrelacion entre el consumo de alcohol y los opiaceos. En principio el individuo puede beber`por dos motivos, 1) porque se encuentra mal, bebe y se pone algo mejor pero enseguida le baja el alcohol y entonces se le acentua el sindrome de abstinencia (del alcohol y de los opiaceos si los toma), en ese momento necesita tomar un opiaceo para recuperarse y si no lo tiene probablemente beberá mas. 2) motivo: porque se encuentra bien (ha tomado un opiaceo que le hace sentirse mejor animicamente y le apetece beber un poco para estar un poco alegre con los amigos, por ejemplo), en este caso, al poco rato, le ocurre igual que antes cuando le baja el efecto necesita mas opiaceo para recuperarse del sindrome de abstinencia que le reagudiza el descenso del nivel de alcoholemia. ¡¡¡¡Es curioso pero en los adictos, el opiaceo suele despejar de la borrachera!!!!! RESUMEN: alcohol intake always needs more methadone, because in the end methadone helps to recober from depresion. Patients must be talk to realise methadone makes them feel better but they shouldn't drink alcohol because if so they will need more methadone for bigger withdrawal.
I would like to be able to write in English correctly, but I find it very difficult when I want to explain something as complicated and important as the comment made by Dr. Newman. I will start by giving my opinion based on years of treatment and observation of opiates addicts also consuming alcohol. Methadone in adequate doses helps to reduce the consumption of alcohol, provided the addicted patient wants to recover, because the effect of opioids is controversial, the good feeling that they produce can promote alcohol consumption desire to "enjoy friends, various situations, etc."; for this reason in psychotherapy the patient must be advised strongly of this peculiarity, in addition you must penalize alcohol and cocaine consumption with suitable interventions like raising the dose of methadone and such other things. However the other side of the coin is even worse, without methadone (as mentioned by Dr. Newman) the addict to opiates and/or alcohol cannot expect to quit heroin, or alcohol. So that I am totally agree with Dr. Newman opinion, we must not reduced methadone dose because patient arrives [at the methadone clinic] obviously inebriated.
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