Methadone Replacement Therapy

- Methadone Replacement Therapy (MRT) is one of the "Harm Reduction"

program established for opioid abusers.
- The aim of this program is mainly to
o prevent blood-borne viral infections (HIV, Hepatitis C, Hepatitis
B) due to needles sharing.
o Improve quality of life
o Reduce craving and withdrawal symptoms.
- Synthetic Opioid Agonist.

Pharmacology time of onset: 30 min

peak effects: 3 hours
Half life : 24 hours
Time to reach stabilization: 3 to 10 days
Side effects - Drowsiness
- Nausea and vomiting
- Difficulty in urination
- Mood changes
- Sleep problems
- Decrease in sexual desire and ability
Contraindications - Primary addiction not opioid based
- Severe hepatic impairment
- Hypersensitivity to methadone
- Severe respiratory depression
- Head injury
- Raised ICP
- Acute Alcoholism
- Receiving MAOI or within 14 days of stopping such
treatment
- Addiction less than 1 year
Criteria for MRT - Above 18 years old
- Voluntary
- Primary addiction opiate based drugs
- Adhere to rules and regulation
Termination of - Aggression, causing damage to property and physical
MRT well being of staffs
- Misuse of take away dosage
- Distributing drugs at treatment facility
- Verbal threats
Investigations - Infective status -TB/HIV/HEP B Hep C
prior to initiation - LFT
- Urine for drugs
- ECG - for those taking 100mg and above. (QTc)
Treatment
Induction Titration Maintenance dosing
phases
• starting dose 20- • 1st two weeks is • may require higher
30mg mainly aimed at doses during
• followed by achieving maintenance than
monitoring for 3-4hrs stabilization induction phase
for signs of according to patient's • usually ranges
toxicity/withdrawal. needs between 60-80mg
• If develops • 5-10mg increment • take into
withdrawal within every 3 days consideration the
4hrs, consider taking • not more than 20mg following:
5mg total increase per opatient's metabolism
• may consider week opregnancy
starting at doses • end dose in 1st week opolysubstance
higher than 30mg is not to exceed
oother medications:
but no more than 50mg
antiTB/ Antiretroviral/
40mg • advise patient not to psychotropics
• monitor for 3-4hr for handle machinery or
the first 3 days drive during titration
phase

Patient - Should be done actively during first 2 weeks of induction

Surveillance - Ideally daily by MO
- At least 2 x in a week
- Considerations
o Withdrawal
o Intoxication
o Other drug use
o Adherence to rules
o Patient’s perception to dosage adequacy.
Dose reduction - 10mg reduction per week till dosage is 40mg
- Then 5mg reduction per week
-