LONG TERM DETOXIFICATION OF REHABILITATED METHADONE PATIENTS

Abstract

The psychological, physical and behavioral response of 16 rehabilitated methadone patients to gradual methadone detoxification was studied over a two-year period. Patients were monitored from pre-detoxification baseline levels of functioning through gradual withdrawal and 4-week Placebo and 4-week Post Placebo periods by means of a standard symptom interview conducted twice a week and psychological testing conducted once every two weeks. Four non-projective tests were used to assess levels of depression, anxiety and hostility. The response of detoxifying patients was compared with a contrast group of 6 methadone-maintained patients at the same clinic matched for degree of rehabilitation, who were similarly studied but who did not detoxify from the treatment drug.;Physical and behavioral symptoms of detoxifying patients increased significantly as daily methadone levels decreased below 30 mg/day. Detox patients had more physical symptoms, weight loss, and behavioral problems over time (decreasing dose) than the contrast group. No significant differences were found on psychological mood tests at high versus low methadone doses or between the two groups. Detox patients were very sensitive to methadone dose changes and were able to estimate with a high degree of accuracy the amount of methadone ingested daily in the absence of taste cues and without knowledge of actual dosage.;Of the 16 patients who attempted to be withdrawn from methadone, 4 were unable to reach zero dosage and were retreated, 3 were known to be functioning well a short time after reaching zero dosage, 4 were 'probaby' doing well, but follow-up was incomplete, 1 developed very serious behavior problems during and following detoxification, 2 patients relapsed to heroin abuse, and 2 patients became alcohol-addicted following detoxification from methadone.;It was concluded that methadone patients withdrawing slowly from their treatment drug experience many symptoms, the most severe of which is social upheaval in terms of behavioral problems not demonstrated prior to detoxification. The disruption in psychosocial functioning correlated with detoxification was marked in some cases. It was hypothesized that no dose relationship in anxiety, depression or hostility was found because the impulsive behaviors that ensued at low methadone doses discharged the heightened affects as they occurred, and that self-medication with drugs both altered mood state and potentiated narcotic effects of the available methadone level. It is also possible that the psychological mood tests themselves may be insufficiently sensitive to transitory subjective effects in this group of patients.;('1)This research was supported by NIDA grant No. 5 H80 DA00924-03.