Najari, Fares

English

Journals Portal, Shahid Beheshti University of Medical Sciences

1Citation: Najari F. The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment). International Journal of Medical Toxicology & Forensic Medicine. 2018; 8(1):1-4. http://dx.doi.org/10.22037/ijmtfm.v8i1(Winter).19046 :  http://dx.doi.org/10.22037/ijmtfm.v8i1(Winter).19046Use your device to scan and read the article onlineLetter to Editor: The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment)Addiction is one of the dilemmas of today Iranian so-ciety. Better understanding of addiction outcomes, plan-ning to control and reduce the number of addicts, as well as improving the prognosis of addiction are among the Iranian policy makers priorities. Methadone Mainte-nance Treatment (MMT) is one of the methods used to help addicts have better control over the consumption of opioids [1, 2]. Methadone has 2 main advantages. First, it induces lower trance, compared with that of heroin and second its longer half-life that causes larger bioavailability, unlike heroin that induces a quick mental response, trance, and subsequently hangover. The patient who uses heroin feels trance, hangover, and fluctuation throughout the day, but the one who consumes metha-done feels and behaves within normal range [3-11]. Of course methadone consumption like other opioids is associated with some side-effects like physical de-pendence, nausea and vomiting, constipation, suppres-sion of respiratory system, coma, or cardiac and liver complications. Patients usually tolerate most of such complications, but methadone is somehow different from other opioids; for instance, it has longer half-life, which varies in different people. Methadone is exten-sively distributed in the body but may be accumulated in different organs following the continuous consump-tion [12-18]. Most of the methadone-associated side-effects are caused by its early and or late complications; reports stated by the Iranian Forensic Organization and Medi-cal Centers indicate high rate of methadone-associat-ed mortality. As a result, it was decided to prescribe MMT program just for the homeless addicts or the ones who lost their social function anyway. However, it was gradually prescribed for all patients due to lack of monitoring as well as its lower cost and availability [19-21], to the extent that today almost all drug abuse treatment centers prescribe or at least start MMT for all clients. Based on the rigorous and proven scientific evaluations, long-term methadone use can cause seri-ous injuries like cardiac and liver problems and severe physical dependence. In other words, it is like jump out of the frying pan and into the fire; available figures indicate such dilemma. Hence, the following items are recommended to improve the current messy situation of addiction treatment.1. Methadone and other drug abuse treatment drugs are provided directly as usual to the treatment cen-ters, which seems unscientific and irrational due to insecure margins regarding the storage, maintenance, and distribution of such drugs. Addiction withdrawal medicines, enclosed with the leaflet or instructions, should be available in pharmacies throughout the city and placed at the disposal of addicts by prescriptions or the pharmacists like any other medicine; the effects and outcomes of this rational policy can be assessed in the long-term follow up. 2. It is recommended to remove the prescription of methadone from the therapeutic protocol for patients over 50 years old because of its high complications and side-effects of MMT as well as intolerance and former withdrawal symptoms that hurt the patients at least for 3 months and result in the simultaneous consumption of methadone and former opioid by the patient [22-24].  Although addiction treatment needs a therapeutic team comprising of a phycologist, inter-nist, forensic physician and toxicologist, and social worker as well as the trustees from Iranian Ministry of Labor and Social Affairs, clients are commonly un-dergone treatment based on a psychological approach and addiction withdrawal expressions, and most of the officials in treatment centers only took the responsi-bility just by attending a 2- or 3-week training course and are unaware of the side effects of such treatments. Winter 2018, Volume 8, Number 12 Najari F. The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment). IJMTFM. 2018; 8(1):1-4.As a result, the policy makers of Iranian Ministry of Health and Medical Education should take required measures; in other words, an ounce of prevention is worth a pound of cure.3. Addicts, like any other patients, have the right to be admitted in public or private addiction treatment centers or refer to physicians and receive treatment. Establishment of addiction treatment centers (with their negative psychological burden on the commu-nity) reduces the success rate of treatment programs in such an extent that completely undermines the activity of such centers so that their shutting down seems more rational.Fares Najari1*1. Department of Forensic Medicine, School of Medicine, Shahid Be-heshti University of Medical Sciences, Tehran, Iran.References[1] United Nations Office on Drugs and Crime. World drug re-port 2016. New York: United Nations Publications; 2016.[2] Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, Hajebi A, Radgoodarzi R, Mojtabai R, et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction. 2016; 111(10):1836–47. doi: 10.1111/add.13453. [3] Eskandarieh S, Hajebi A, Noroozi A, Haghdoost AA, Baneshi MR. Epidemiology of Alcohol Abuse in Iran. Asia Pacific Journal of Medical Toxicology. 2014; 3(1):22. doi: 10.22038/APJMT.2014.2905. [4] Bagheri Lankarani K, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Medical Journal of The Islamic Republic of Iran. 2013; 27(1):42–9. PM-CID: PMC3592943[5] Lankarani KB, Afshari R. Alcohol consumption in Iran. Lancet. 2014; 384(9958):1927–8. doi: 10.1016/S0140-6736(14)62279-0. [6] Alam-Mehrjerdi Z, Daneshmand R, Samiei M, Samadi R, Abdollahi M, Dolan K. Women-only drug treatment ser-vices and needs in Iran: the first review of current literature. DARU Journal of Pharmaceutical Sciences. 2016; 24(1):1. doi: 10.1186/s40199-016-0141-1. [7] Tavakoli M, Mohammadi L, Yarmohammadi M, Farhou-dian A, Ja’fari F, Farhadi MH. [Status and trend of substance abuse and dependence among Iranian women (Persian)]. Journal of Rehabilitation. 2014; 14(5):30–7.[8] Johnston LD, O’Malley PM, Bachman JG. Monitoring the future: National survey results on drug use, 1975–2001. Vol-ume II. Bethesda: NIH Publication; 2012.[9] Van Etten ML, Anthony JC. Male–female differences in transitionsfrom first drug opportunity to first use: Searching for subgroup variation by age, race, region, and urban status. Journal of Women's Health & Gender-Based Medicine. 2001; 10(8):797–804. doi: 10.1089/15246090152636550. [10] Kim JY, Fendrich M. Gender differences in juvenile arrestees’drug use, self-reported dependence, and perceived need for treatment. Psychiatric Services. 2002; 53(1):70–5. doi: 10.1176/appi.ps.53.1.70. [11] Lex B. Some gender differences in alcohol and polysub-stance users. Health Psychology. 1991; 10(2):121–32. doi: 10.1037/0278-6133.10.2.121. [12] Merikangas KR, McClair VL. Epidemiology of substance use disorders. Human Genetics. 2012; 131(6):779–89. doi: 10.1007/s00439-012-1168-0. [13] Greenfield SF, Back SE, Lawson K, Brady KT. Substance abuse in women. Psychiatric Clinics of North America. 2010; 33(2):339–55. doi: 10.1016/j.psc.2010.01.004. [14] Beaudoin FL, Baird J, Liu T, Merchant RC. Sex differ-ences in substance use among adult emergency department patients: prevalence, severity, and need for intervention. Academic Emergency Medicine. 2015; 22(11):1307–15. doi: 10.1111/acem.12810. [15] Hammerslag LR, Gulley JM. Sex differences in behavior and neural development and their role in adolescent vulner-ability to substance use. Behavioural Brain Research. 2016; 298:15–26. doi: 10.1016/j.bbr.2015.04.008. [16] Ziaaddini H, Ziaaddini MR. The household survey of drug abuse in Kerman, Iran. Journal of Applied Sciences. 2005; 5(2):380–2. doi: 10.3923/jas.2005.380.382. [17] Dolan K, Salimi S, Nassirimanesh B, Mohsenifar S, Mokri A. The establishment of a methadone treatment clinic for women in Tehran, Iran. Journal of Public Health Policy. 2011; 32(2):219–30. doi: 10.1057/jphp.2011.10. [18] Dolan K, Salimi S, Nassirimanesh B, Mohsenifar S, Allsop D, Mokri A. Characteristics of Iranian women seeking drug treatment. Journal of Women's Health. 2011; 20(11):1687–91. doi: 10.1089/jwh.2010.2694. [19] Hojjat SK, Hatami SE, Rezaei M, Hamidi M, Norozi Khalili M. Women in opioid maintenance treatment in Iran: Back-ground characteristics and history of substance use and risk behaviors. Journal of Substance Use. 2016; 22(4):377–83. doi: 10.1080/14659891.2016.1227381[20] Sharifi V, Assadi SM, Mohammadi MR, Amini H, Ka-viani H, Semnani Y, et al. A Persian translation of the structured clinical interview for diagnostic and statistical manual of mental disorders: psychometric properties. Com-prehensive Psychiatry. 2009; 50(1):86–91. doi: 10.1016/j.comppsych.2008.04.004. [21] Zolala F, Mahdavian M, Haghdoost AA, Karamouzian M. Pathways to addiction: a gender-based study on drug use in a triangular clinic and drop-in center, Kerman, Iran. Interna-tional Journal of High Risk Behaviors and Addiction. 2016; 5(2). doi: 10.5812/ijhrba.22320.[22] Zhang Y, Lu C, Zhang J, Hu L, Song H, Li J, et al. Gender differences in abusers of amphetamine-type stimulants and ketamine in southwestern China. Addictive Behaviors. 2013; 38(1):1424–30. doi: 10.1016/j.addbeh.2012.06.024.Winter 2018, Volume 8, Number 13[23] Shekarchizadeh H, Ekhtiari H, Khami MR, Virtanen JI. Patterns of pre-treatment drug abuse, drug treatment his-tory and characteristics of addicts in methadone maintenance treatment in Iran. Harm Reduction Journal. 2012; 9(1):18. doi: 10.1186/1477-7517-9-18.[24] McHugh RK, DeVito EE, Dodd D, Carroll KM, Potter JS, Greenfield SF, et al. Gender differences in a clinical trial for prescription opioid dependence. Journal of Substance Abuse Treatment. 2013; 45(1):38–43. doi: 10.1016/j.jsat.2012.12.007. Winter 2018, Volume 8, Number 14Winter 2018, Volume 8, Number 1

The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment)

https://journals.sbmu.ac.ir/ijmtfm/article/download/19046/pdf

The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment)

Abstract

Similar works

Full text

Available Versions

Journals Portal, Shahid Beheshti University of Medical Sciences