METADONSKI PROGRAM

Nevena G Ivanović

doi:10.5937/racter8-9730

Nevena G Ivanović Fakultet Medicinskih Nauka, Integrisane akademske studije farmacije

DOI: https://doi.org/10.5937/racter8-9730

Ključne reči: methadone||, ||metadon, maintenance treatment||, ||supstituciona terapija, opioid dependence||, ||opioidna zavisnost, review||, ||pregledni članak,

Sažetak

Metadonska terapija je preporučena od Svetske zdravstvene organizacije kao osnovni model lečenja opijatskih zavisnika. Supstituciona terapija metadonom ublažava mnoge apstinencijalne simptome koje zavisnici doživljavaju i smanjuje zdravstvene i društvene rizike.

Pretraživana je literatura o načinu sprovođenja i karakteristikama metadonskog programa je u medicinskoj baza podataka Medline. Analizirane su publikovane studije o karakteristikama metadonske terapije u više zemalja.

Supstituciona terapija metadonom je izrazito razvijena u Švajcarskoj gde je od 1989 do 2000 godine povećan broj sa oko 5000 pacijenata na 18 000 pacijenata. Od 1996 u Francuskoj se primenjuju metadon i buprenorfin. U Irskoj krajem 2009 godine je registrovano 8.551 pacijenata na metadonskom programu u poređenju sa 5.965 pacijenata krajem 2002 godine. U Njujorku sprovedena je studija čiji rezultati pokazuju da metadon intravenski zloupotrebljava 71,9% korisnika metadonskog programa a da 64,7% prodaje. U mnogim centrima u Španiji i Irskoj kriterijumi za prinudno prekidanje terapije je nasilje i zloupotreba ovih supstanci. Ispitanici smatraju da bi zaposleni trebalo da im ukažu na sva neželjena dejstva. Sugestija pacijenata je bila i da se produži radno vreme klinika. Zaposleni smatraju da puno radno vreme 365 dana u toku godine je uzrok grešaka u toku rada. U Irskoj problem sa kojim se susreću zaposleni su značajne razlike u pristupu lečenja metadonom u različitim delovima zemlje. Studije ukazuju na nezadovoljstvo pacijenata finansijskim stanjem jer oni sami plaćaju terapiju ili su nepotrebno duže na lečenju.

Biografija autora

Nevena G Ivanović, Fakultet Medicinskih Nauka, Integrisane akademske studije farmacije

Magistar farmacije

Reference

Славица Ђ. Дејановић. Психијатрија: прво издање. Медицински факултет у Крагујевцу. 2011. 348-53.

Вучковић Н, Дицков А, Ковачевић М, Симоновић П, Николић М, Јовановић М, et al. Супституциона терапија зависника од опијата. Измена и допуна националних смерница. Београд: Министарство здравља Републике Србије, Републичка стручна комисија за превенцију и контролу болести зависности. 2012.

Ministarstvo zdravlja i socijalne skrbi Republike Hrvatske. Smjernice za farmakoterapiju opijatskih ovisnika netadonom. Dostupno na http://www.emcdda. europa.eu/attachements.cfm/att_102315_EN_Guidelines%20for%20methadone%20treatment-1.pdf

Nicholls L, Bragaw L, Ruetsch C. Opioid dependence treatment and guidelines. J Manag Care Pharm. 2010; 5: 14-21.

Wu ZY, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. (2007). Evolution of China’s response to HIV/AIDS. Lancet. 2007; 369: 679–90.

Modesto-Lowe V, Brooks D, Petry N. Methadone deaths: risk factors in pain and addicted populations. J Gen Intern Med. 2010; 25(4): 305-9.

Слободан М. Јанковић. Фармакологија и токсикологија. 3. издање. Крагујевац: Медицински факултет у Крагујевцу; 2011: 144.

Варагић В, Милошевић М. Фармакологија. 20. прерађено и допуњено издање. Београд: Elit Medica. 2005; 213.

Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options. J Natl Med Assoc. 2012; 104(7): 342-50.

Brajkovic G, Rancic D, Kilibarda V, Ercegovic G, Vukcevic N, Krstic N. Qantitative determination of methadone and its metabolite EDDP using liquid chromatography method. MD-Medical Data. 2013; 5 (3): 297-302.

Overholser BR, Foster DR. Opioid pharmacokinetic drug-drug interactions. Am J Manag Care. 2011; 11: 276-87.

Mehić-Basara N, Hasečić H, Pokrajac M, Selman S. Vodič za primjenu metadona kod ovisnika o opijatima. Sarajevo: Ministarstvo zdravlja kantona Sarajevo. 2007

Доступно на http://www.ncbi.nlm.nih.gov/pubmed/

Annette Verster, Ernst Buning. Methadone Guidelines. Project European Commission. 2000. 34-46.

Torrens M, Fonseca F, Castillo C, Domingo-Salvany A. Methadone maintenance

treatment in Spain: the success of a harm reduction approach. Bull World Health Organ. 2013; 91(2): 136-4.

Huissoud T, Rousson V, Dubois-Arber F. Methadone treatments in a Swiss region, 2001-2008: a registry-based analysis. BMC Psychiatry. 2012; 12: 238.

Wickersham JA, Marcus R, Kamarulzaman A, Zahari MM, Altice FL. Implementing methadone maintenance treatment in prisons in Malaysia. Bull World Health Organ. 2013; 91(2): 124-9.

Roux P, Michel L, Cohen J, Mora M, Morel A, Aubetin JF, Desenclos JC, Spire B, Carrieri PM; ANRS Methaville Study Group. Methadone induction in primary care (ANRS-Methaville): a phase III randomized intervention trial. BMC Public Health. 2012;12: 488.

The Introduction of the Opioid Treatment Protocol. 2010. Доступно на: http://www.drugs.ie/ resourcesfiles/reports/Opioid_Treatment_Protocol.pdf

Serpelloni G, Gomma M, Genetti B, Zermiani M, Rimondo C, Mollica R, Gryczynski J, O'Grady KE, Schwartz RP. Italy's electronic health record system for opioid agonist treatment. J Subst Abuse Treat. 2013; 45(2): 190-5.

Sindelar JL, Fiellin DA. Innovations in treatment for drug abuse: solutions to a public health problem. Annu Public Health. 2001; 22: 249-72.

Drug misuse Psychosocial interventions.National Clinical Practice Guideline Number 51. The British Psychological Society and The Royal College of Psychiatrists. 2008. Доступно на: http://www.nice. org.uk/guidance/cg51/resources/cg51-drug-misuse-psychosocial-interventions-full-guideline2

Вучковић Н, Дицков А, Ковачевић М, Кишдобрански, М., Недић, С., Мартиновић- Митровић, С., Драгић, Н., Будиша, Д. Супституциона терапија зависника од опијата метадоном – националне смернице за лекаре у примарној здравственој заштити. Београд: Министарство здравља Републике Србије. 2009.

Wu F, Peng CY, Jiang H, Zhang R, Zhao M, Li J, Hser YI. (2013). Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients. J Public Health (Oxf). 2013; 35(2): 206-12.

Ordean A, Kahan M, Graves L, Abrahams R, Boyajian T. Integrated care for pregnant women on methadone maintenance treatment: Canadian primary care cohort study. Can Fam Physician. 2013; 59(10): 462-9.

Sohler NL, Weiss L, Egan JE, López CM, Favaro J, Cordero R, Cunningham CO. Consumer attitudes about opioid addiction treatment: a focus group study in New York City. J Opioid Manag. 2013; 9(2): 111-9.

Lin C, Wu Z, Detels R. Opiate users' perceived barriers against attending methadone maintenance therapy: a qualitative study in China. Subst Use Misuse. 2011; 46(9): 1190-8.

Trujols J, Siñol N, Iraurgi I, Batlle F, Guàrdia J, Pérez de Los Cobos J. Patient and clinician's ratings of improvement in methadone maintained patients: Differing perspectives. Harm Reduct J. 2011; 8(1): 23.

Sherman SG, Cheng Y, Kral AH. Prevalence and correlates of opiate overdose among young injection drug users in a large U.S. city. Drug Alcohol Depend. 2007; 88(3): 182-7.

Scherbaum N, Kluwig J, Meiering C, Gastpar M. Use of illegally acquired medical opioids by opiate-dependent patients in detoxification treatment. Eur Addict Res. 2005; 11(4): 193-6.

Sharifa Ezat WP, Noor Azimah H, Rushidi R, Raminder K, Ruhani I. Compliance towards methadone maintenance therapy and its associated factors in Selangor primary care centers and Kuala Lumpur hospital. Med J Malaysia. 2009; 64(1): 65-70.

Ramli M, Zafri AB, Junid MR, Hatta S. Associated risk factors to Non-compliance to Methadone Maintenance Therapy. Med J Malaysia. 2012; 67 (6): 560-4.

Lin C, Wu Z, Detels R. Family support, quality of life and concurrent substance use among methadone maintenance therapy clients in China. Public Health. 2011;125(5): 269-74.

Strang J, Hall W, Hickman M, Bird SM. Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): analyses using OD4 index in England and Scotland. BMJ. 2010; 341: 4851.

Department of Health (England) and the devolved administrations. Drug Misuse and Dependence: UK Guidelines on Clinical Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive. 2007.

Cerovečki V, Tiljak H, Adžić Z, Križmarić M, Pregelj P, Kastelic A. Risk factors for fatal outcome in patients with opioid dependence treated with methadone in a family medicine setting in Croatia. Croat Med J. 2013; 54(1): 42-8.

Richert T, Johnson B. Illicit use of methadone and buprenorphine among adolescents and young adults in Sweden. Harm Reduct J. 2013; 10: 27.

Davis WR, Johnson BD. Prescription opioid use, misuse, and diversion among street drug users in New York City. Drug Alcohol Depend. 2008; 92: 267-76.

Zhao Y, Shi CX, McGoogan JM, Rou K, Zhang F, Wu Z. Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China. Bull World Health Organ. 2013; 91(2): 93-101.

Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012; 31(3): 207-25.

Hamilton AB, Grella CE. Gender differences among older heroin users. J Women Aging. 2009;21(2): 111-24.

Lin C, Wu Z, Rou K, Pang L, Cao X, Shoptaw S, Detels R. Challenges in providing services in methadone maintenance therapy clinics in China: service providers' perceptions. Int J Drug Policy. 2010; 21(3): 173-8.

Јаковљевић М, Јовановић М. Садашњи статус и трошкови лечења опиоидне зависности у домаћем здравственом сектору. Психијатрија данас. 2011; 47: 193-7.

Zaric GS, Brennan AW, Varenbut M, Daiter JM. The cost of providing methadone maintenance treatment in Ontario,Canada.Am J Drug Alcohol Abuse. 2012; 38(6): 559-66.

Sullivan S. Opioid substitution: improving cost-efficiency. Bull World Health Organ. 2013;91(2): 83.

McCowan C, Kidd B, Fahey T. Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. BMJ. 2009; 338: 222.

Chen KW, Berger CC, Forde DP, D'Adamo C, Weintraub E, Gandhi D. Benzodiazepine use and misuse among patients in a methadone program. BMC Psychiatry. 2011; 11: 90.

Guidelines for the Psychosocially Assisted Phar-macological Treatment of Opioid Dependence. WHO Library Cataloguing-in-Publication Data. 2009. Доступно на: http://whqlibdoc.who.int/publications/ 2009/9789241547543_eng.pdf?ua=1

Shiran MR, Lennard MS, Iqbal MZ, Lagundoye O, Seivewright N, Tucker GT, Rostami-Hodjegan A. Contribution of the activities of CYP3A, CYP2D6, CYP1A2 and other potential covariates to the disposition of methadone in patients undergoing methadone maintenance treatment. Br J Clin Pharmacol. 2009; 67(1): 29-37.

Kharasch ED, Walker A, Whittington D, Hoffer C, Bedynek PS. Methadone metabolism and clearance are induced by nelfinavir despite inhibition of cytochrome P4503A (CYP3A) activity. Drug Alcohol Depend. 2009; 101(3): 158-68.

Kharasch ED, Bedynek PS, Park S, Whittington D, Walker A, Hoffer C. Mechanism of ritonavir changes in methadone pharmacokinetics and pharma-codynamics: I. Evidence against CYP3A mediation of methadone clearance. Clin Pharmacol Ther. 2008; 84(4): 497-505.

Nyamathi A, Albarrán CR, Branson C, Marfisee M, Khalilifard F, Leake B. Correlates of depressive symptoms among alcohol-using methadone maintained adults. Am J Addict. 2012; 21: 49-55.

Field CA, Klimas J, Barry J, Bury G, Keenan E, Smyth BP, Cullen W. Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. BMC Fam Pract. 2013; 14: 98.

Nyamathi A, Cohen A, Marfisee M, Shoptaw S, Greengold B, de Castro V, George D, Leake B. Correlates of alcohol use among methadone-maintained adults. Drug Alcohol Depend. 2009;101(2): 124-7.