Defining dosing pattern characteristics of successful tapers following methadone maintenance treatment: results from a population-based retrospective cohort study.
Addiction
; 107(9): 1621-9, 2012 Sep.
Article
en En
| MEDLINE
| ID: mdl-22385013
ABSTRACT
AIMS:
To identify dose-tapering strategies associated with sustained success following methadone maintenance treatment (MMT).DESIGN:
Population-based retrospective cohort study.SETTING:
Linked administrative medication dispensation data from British Columbia, Canada.PARTICIPANTS:
From 25 545 completed MMT episodes, 14 602 of which initiated a taper, 4183 individuals (accounting for 4917 MMT episodes) from 1996 to 2006 met study inclusion criteria. MEASUREMENTS The primary outcome was sustained successful taper, defined as a daily dose ≤5 mg per day in the final week of the treatment episode and no treatment re-entry, opioid-related hospitalization or mortality within 18 months following episode completion.FINDINGS:
The overall rate of sustained success was 13% among episodes meeting inclusion criteria (646 of 4917), 4.4% (646 of 14 602) among all episodes initiating a taper and 2.5% (646 of 25 545) among all completed episodes in the data set. The results of our multivariate logistic regression analyses suggested that longer tapers had substantially higher odds of success [12-52 weeks versus <12 weeks odds ratio (OR) 3.58; 95% confidence interval (CI) 2.76-4.65; >52 weeks versus <12 weeks OR 6.68; 95% CI 5.13-8.70], regardless of how early in the treatment episode the taper was initiated, and a more gradual, stepped tapering schedule, with dose decreases scheduled in only 25-50% of the weeks of the taper, provided the highest odds of sustained success (versus <25% OR 1.61; 95% CI 1.22-2.14).CONCLUSIONS:
The majority of patients attempting to taper from methadone maintenance treatment will not succeed. Success is enhanced by gradual dose reductions interspersed with periods of stabilization. These results can inform the development of a more refined guideline for future clinical practice.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Tratamiento de Sustitución de Opiáceos
/
Metadona
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Trastornos Relacionados con Opioides
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Narcóticos
Tipo de estudio:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
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Female
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Humans
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Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Addiction
Asunto de la revista:
TRANSTORNOS RELACIONADOS COM SUBSTANCIAS
Año:
2012
Tipo del documento:
Article
País de afiliación:
Canadá