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Methadone Dose Adjustments, Plasma R-Methadone Levels and Therapeutic Outcome of Heroin Users: A Randomized Clinical Trial

2018; Karger Publishers; Volume: 24; Issue: 1 Linguagem: Inglês

10.1159/000485029

1421-9891

Guido Mannaioni, Cecilia Lanzi, Michela Lotti, Valentina Galli, Arianna Totti, Ilaria Pacileo, Maria Sili, Chiara Pracucci, Arianna Dilaghi, Lara Bertieri, Mariarita Quaranta, Francesco Orsini, Brunella Occupati, Assia Michahelles, Riccardo Ciuti, Elisa Bianchini, Giancarlo Fabbro, Annibale Biggeri, Emanuela Masini, Flavio Moroni,

Treatment of Major Depression

<b><i>Aims:</i></b> We aimed to improve the retention in treatment and therapeutic outcome of methadone maintenance treatment (MMT) patients by adjusting the oral methadone dose in order to reach a “target” plasma R-methadone level (80–250 ng/mL). <b><i>Methods:</i></b> A multicenter randomized controlled trial was organized. <b><i>Results:</i></b> The intention-to-treat statistical analysis showed that repeated dose adjustments performed in order to obtain therapeutic plasma R-methadone levels did not improve retention in treatment of heroin-dependent patients. However, patients having plasma methadone levels in the “target range” at the beginning of the study had a better retention in treatment than controls. Furthermore, patients succeeding in keeping plasma R-methadone target levels (per protocol analysis) remained in treatment and improved their social scores better than controls. ­<b><i>Conclusion:</i></b> Although the primary endpoint of this study was not demonstrated, a post hoc and a per protocol analysis suggested that patients in MMT with plasma R-methadone concentrations in the target range have a better therapeutic outcome than controls.