Bolton, Judi; (1997) The acute effects of methadone on long-term users. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Methadone is the most commonly prescribed drug for the treatment of opiate dependency. The effects of methadone on cognition have been rarely examined. This study investigates the effects of an extra dose of methadone on long-term methadone users. Measures included in the study assess the effects of methadone on mood, cognition, psychomotor performance, craving, coping and suggestibility. The project was undertaken at Camden & Islington addiction treatment service. A double-blind, placebo controlled cross-over design was employed. Eighteen participants were recruited and tested on two separate occasions with a week between each testing session. All participants were given a third increase in their daily methadone dose. Most participants had been using opiates for between 2 and 5 years and all participants had been taking methadone for a minimum of six months. The average daily methadone dose was 43.5mls, however 22% of the participants were buying illicitly additional methadone and 67% of participants reported using heroin in the last week. The use of additional opiates was validated by urinalysis results. 28% of participants had not reported heroin use in the last 72 hours despite a positive urine result. Interestingly, 2-3 hours post drug administration participants were unable to identify whether they had been given methadone or placebo. Additional methadone did not significantly alter any aspects of psychomotor or cognitive functioning. However, the research sample did vary from the standardized population sample on the digit cancellation task. Although the memory task impairment did not reach statistical significance it is notable that a fifth of participants scored lower than the standardised sample. Methadone had a significant effect on craving. An increase in methadone dose increased participants' craving for heroin and the implications of this are discussed. Suggestibility did not alter with an additional methadone dose but there was a significant difference between the research sample and the standardised sample with drug users being significantly less suggestible. The possible effects of this finding on clinical management are discussed. Methadone users were found to significantly differ from the general population on the coping strategies that they adopt. These results are discussed with reference to the current literature and targets for further research are identified. Clinical implications for drug services and for clients are drawn out.

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