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When people receive methadone treatment for opioid use disorder, their use of the dangerous drugs heroin and fentanyl significantly declines, a new study shows.
But decreases in cocaine or methamphetamine use were not seen in a year of treatment, researchers report.
“Methadone treatment can have tremendous success reducing fentanyl and heroin use in individuals, but this study shows we aren't addressing the complexity of polysubstance use,” said study lead author Brendan Saloner, an associate professor at Johns Hopkins Bloomberg School of Public Health in Baltimore.
“The findings clearly sound an alarm bell that we need more tools to support other types of substance use,” Saloner added in a school news release.
The findings are important, given the U.S. drug crisis. Drug overdose deaths rose from over 12,100 in 2015 to nearly 53,500 in 2021, according to the U.S. National Institutes of Health. Fentanyl, a powerful synthetic opioid, is a key driver in those deaths.
In the study, those who tested positive for fentanyl during the first year of methadone treatment declined on average from about 22% in week one to just over 17% in week 52.
The heroin positivity rate was halved, dropping from about 8% to about 4%. The biggest declines for both fentanyl and heroin were seen in the first 10 weeks of treatment.
“At the same time, the prevalence of methamphetamine and cocaine use is on the rise and is not generally decreasing during a year in methadone treatment. These findings will help clinicians identify patients who are at greater risk and can offer additional support,” Saloner said.
Researchers analyzed urine-specimen findings from patients receiving treatment at methadone clinics from 2017 to 2021. The study involved more than 16,000 people from 10 U.S. states: Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia and Washington.
Across the five-year study period, the first urine specimens collected indicated increasing fentanyl positivity rates in the broader population, from about 13% in 2017 to 53% in 2021. The positivity rate for methamphetamine also increased, from about 11% to more than 27%. The rate of cocaine use also rose, from almost 14% to nearly 20%.
Fentanyl positivity was significantly higher for males compared to females, and higher in the 18 to 24 age group.
Methadone is approved by the U.S. Food and Drug Administration to treat the cravings and withdrawal common in opioid use disorder.
The U.S. National Institute on Drug Abuse funded the study. Findings were published online May 9 in the journal Addiction.
The U.S. Centers for Disease Control and Prevention has more on fentanyl.
SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, May 9, 2023
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