Agonist and antagonist substitution evaluation

What did Gowing et al (2001) find regarding agonists?

Methadone programmers very effective at reducing physical and social harms associated with drug use. Typically, the longer someone remains in treatment the better their outcomes and lower relapse.

What did NICE find when reviewing methadone?

31 reviews found addicts who had methadone were less likely to relapse than addicts who had a placebo or no treatment at all.

How does bupronephorine compare methadone?

safer than methadone and harder to overdose however methadone methadone is more effective in keeping heroin addicts in rehab programmes for longer.

Why is methadone a good investment?

Leads to threefold economic benefit in reductions of health and social costs, criminal activity and price of policing. Additionally much longer acting.

Why is Methadone better than heroin?

Can be given once a day compared to heroin needing 2-4 times a day. Stabilises patients life when taken once a day removing cravings. Replaces the reward that heroin gives as heroin is has very low lows.

What is bad about the use of methadone?

It is still extremely addictive and can be fatal when overdosed as well as being diverted into street use.

How is methadone controlled?

Given under supervision ina space for consumption with prepared liquid doses. This can be an expensive process

How does methadone control fail?

Usually operates on weekdays so given 2 takehome doses on Friday however urine testing on Mondays often indicate these doses are not taken.

What does Milroy and Forrest 2000 find about these takehome doses?

Occasionally found by children who drink it as it is usually in a sugar solution and then die of overdose. This results in several deaths per year in the United Kingdom

What does Longford-Hughes 2004 say about the effects of methadone?

Often leaves patients feeling a sense of out of world which patients find limiting in terms of job seeking, success and interpersonal relationships especially when trying to recover from addiction.

What is the key issue regarding antagonists?

Compliance, addict is stripped of reinforcement and pleasure so there is often little incentive to stay compliant.

What did Gowing et al 2001 find regarding antagonists?

Naltrexone is very effective for people who are highly motivated but not as useful for those who are less motivated

How can forceful compliance be good for antagonists?

Blockade of brain mu receptors becomes high so cannot be overcome meaning even huge doses of heroin have little or no effect leading to addict rapidly giving it up

How can low compliance be dangerous when using naltrexone?

Stopping for a day or 2 will allow the full effect of heroin to be felt as tolerance will be lost as a result of naltrexone this can lead to respiratory depression that may lead to death.

Hulse et al (2004)

Tested a naltrexone containing polymer implant which releases antagonist over several months making compliance easier for patient and significantly reduced opioid overdose deaths.

How can antagonists help gambling addictions Ward (2016)

Used 14 patients with significant gambling addictions for whom psychological therapy hadn’t been effective for so given naltrexone, patients showed significant decrease in cravings to gamble. 60% able to abstain completely from gambling and 20% reducing their gambling to almost nothing.

What is wrong with research on these drugs?

Attrition rates are high meaning that only motivated addicts who want to recover are researched.