PATTERNS OF SYMPTOM COMPLAINTS IN METHADONE-MAINTENANCE PATIENTS

Aim. Not all maintenance patients respond to methadone in the same man ner, and many complain of withdrawal symptoms during the 24-hour inter -dosing interval (i.e. the dose does not 'hold'). The persistence of t hese complaints are a source of concern as they may signal unsanctione d drug use and poor treatment outcome. This study examined the prevale nce and profile of symptom complaints in methadone maintenance patient s who report that their methadone dose does not 'hold'. Design. In the first phase, a cross-sectional survey of 114 methadone patients exami ned a range of symptoms including direct opioid effects and withdrawal . Phase 2 involved a comparison of the temporal pattern of symptom com plaints between patients who rt ported the oral dose not 'holding' and those who did not. Setting. Participants in this study were enrolled in the South Australian Public Methadone Maintenance Program. Measurem ents. In Phase 1, a checklist of 21 commonly reported symptom complain ts associated with methadone maintenance treatment was administered. I n Phase 2, this checklist was modified to include only those symptoms that changed in the 24-hour inter-dosing interval The checklist was ad ministered eight times over this period. Further data were collected u sing the Morphine Benzedrine Group Scale of the Addiction Research Cen tre Inventory, a measure of positive opioid effect. Findings. In Phase I, it was found that approximately one-third of the sample reported t hat the methadone dose was consistently inadequate in preventing withd rawal symptoms for the entire inter-dosing interval. They could not be differentiated by demographic, health, other drug use or treatment ch aracteristics. In Phase 2, despite having a higher oral methadone dose , patients reporting that their daily dose did not 'hold' experienced a smaller degree of opioid effect, and a greater intensity of opioid w ithdrawal, during the 24-hour period. Conclusion. These data demonstra te that there is a change in pharmacodynamic response over the 24-hour period for an methadone patients, but the degree of change is greater in a subgroup of patients. Charting symptom presentation throughout t he inter-dosing interval can aid in identifying those patients who are experiencing difficulties with their treatment regime.