Ten Years of Abstinence in Former Opiate Addicts

Pulse template - Pete

I recently stumbled on this article about methadone treatment in Oregon. The above graphic caught my attention.

I found the original study, here are some of the highlights from it’s conclusions. (MMT = methadone maintenance treatment; MR = medication free)

Overall differences:

The results of this study revealed that all in all, MMT patients suffered more poor sleep, chronic pain, and impaired cognitive state compared to MF subjects.

One might assume that the MMT group were more severely addicted. Not so:

Surprisingly and contrary to the preliminary expectations, the MF subjects reported of a more severe history of opioid addiction, significantly higher past amphetamine and lifetime alcohol use scores, and a trend toward a higher lifetime cocaine score than the MMT patients. The ages at onset of all substance use were also significantly younger among the MF subjects. The first type of opioid use was opium among half of the MF group, while among the MMT group—it was heroin. Still, the age of opioid injection onset was younger among the MF persons, and no significant difference was found in the rate of drug injecting.

On differences in psychiatric problems:

There was a substantial group difference in the prevalence of any DSM-IV-TR Axis I psychiatric diagnosis: it was significantly more prevalent among the MMT patients.

On differences in sleep problems:

There were more MMT patients who suffered from poor sleep compared to the MF subjects.

On differences in chronic pain:

High rates of chronic pain among MMT patients are well documented,14,15 and they are, at least partially, most likely related to opioid-induced hyperalgesia (OIH) syndrome. A growing body of evidence that has been accumulated over the last decade suggests that chronic opioid use may unexpectedly worsen the perception of pain in some individuals.32,33 The current study’s finding that MMT patients suffer more from chronic pain may suggest that the substitution of methadone may be related to the presence of hyperalgesia.

On differences in cognitive function:

The MMT patients had worse cognitive function than the MF subjects after excluding psychiatric diagnosis and chronic pain, i.e., when both groups were comparable in sleep quality. A worse cognitive state was despite the fact that MF patients were younger at substance abuse onset, and had longer duration of opiate abuse than the MMT patients. Duration of opiate abuse inversely correlated with cognitive state among MMT patients, but it did not related to the cognitive state among MF persons, possibly due to a ceiling effect. Notably, while the MF group did not abuse any substance through a minimum of 10 years, the MMT patients were not necessarily abstinent throughout a course of at least 10 years’ treatment (mean duration of 14.3 years). Indeed, the mean duration of abstinence for the MMT group was only 7.8 years (range, 2–16 years).

Who were these medication-free people? Here’s what they started off looking for:

. . . the almost impossible mission of finding (and recruiting) prolonged, MF abstinent former opiate dependent individuals (a rarity in itself), who were continuously monitored (urine tests) and followed-up (clinically) for many years. The present study did not manage to find persons who fulfilled all these requirements—but did find persons whose way of life and career, put together with the clinical impression (during the long interview) of the experienced interviewer, and the peers/colleagues reports allowed for the possibility of being close to the point of conviction that they are truly MF abstinent.

Here’s what they did to recruit subjects:

The MF subjects were recruited from various addiction-treatment institutes where they currently work as instructors–counselors. In addition, some of them, by word-of-mouth, informed their peers and colleagues in a snowball-sampling manner; a sampling technique which is often used in hidden populations which are difficult to access. Almost all of the MF subjects (95%) are currently active members in NA programs, and this group includes all available candidates from the various NA program sites in and around the Tel Aviv metropolitan area. This way of recruitment enabled the present study to reach these difficult-to-find individuals and be confident of their long-term abstinence from substances.

Of course, we don’t know what the MF group looked like before initiating their recovery. This limits what we can infer, but it’s a very interesting study.

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4 responses to “Ten Years of Abstinence in Former Opiate Addicts

  1. This is interesting. Chronic opiate use is unhealthy; that’s why abstinence is the ideal outcome. I must say I’m shocked at the late ages reported for first opiate use, first injection and first alcohol use. When I was young we all assumed that such late starters were safe from the risk of addiction. I guess we were wrong again.

  2. johnff

    This article shows the need to be very careful quoting statistics. Data and a fancy chart comparing and drug-free vs methadone clients are given without emphasizing that the study involved only 55 self-selected patients over a 10 year period in Israel! Nothing can be inferred about any other patients anywhere using these data!!

    • You’re right that what we can infer is limited. The study was pretty transparent and didn’t seem to have any agenda. (It appears to have been conducted by staff from the research unit of a MMT clinic.) I also made a point on including their recruitment method, for the purpose of transparency.

      Are you aware of any studies looking at 10 year trajectories for successful MMT and drug-free patients? That seems like something worth studying and this seems like a good start.

      • johnff

        A good source for appreciating the complexity of long term follow-ups is George Vaillant’s work, especially “The Natural History of Alcoholism” and the later “Revisited” book. These efforts followed ~600 men from their pre-alcoholic youth until their seventies. He also did a series of reports spanning 20 years of 100 New York City heroin addicts, starting with their admission to Lexington. Today, it would be difficult to find a pure sample of those who were exposed only to MMT and only drug-free, especially in the States, where typically MMT patients must have had prior drug-free treatment failures. The data would show much more about the culture of treatment than the efficacy of specific methods.