Dose of methadone and positive urinary morphine test in patients receiving methadone maintenance therapy (MMT)

Abstract

Background. Methadone Maintenance Therapy (MMT) is a well-known approach in treatment of Opioid Use Disorders and reduction of harm in these patients. Considering the differences in the pattern of substance use and the instructions for prescribing methadone in our country, this study was performed to evaluate the relationship between methadone dose and positive urinary morphine test in patients receiving MMT. Methods. Clients who were diagnosed as opioid use disorder and has been treated in Razi Hospital in Tabriz were examined. The records of patients receiving MMT were reviewed and their information including demographic information, dose of methadone, number of lapses (based on positive urine morphine tests and the patient's own statements) was evaluated over a 6-month period. Data were analyzed in SPSS 22 and P<0.05 was considered as significant. Results. The mean age of patients was 44 years (15-79 years), the average dose of methadone was 91 (10-175) mg and the mean age of onset of substance use was 26 years. 367 patients were male and 4 were female. The first substance a person consumed was opium and Shireh (opium juice) in 274 cases, cannabis in 11, Shisheh (Methamphetamine) in 4, Kerak and Crystal (A product of heroin) in 28, methadone in 3, tramadol in 5 and heroin in 46 cases. The urine morphine test was negative in 346 cases during 6 months of study while it was positive at one time in 20 cases and 5 cases had a positive test at two times. There was a significant inverse relationship between methadone dose and positive urinary morphine test (P<0.001). Conclusion. Given the significant relationship between positive urinary morphine test and methadone dose, appropriate policies need to be developed to prescribe the minimum effective methadone dose in MMT. To control the disorder and prevent recurrence, urinary morphine tests should be performed more carefully and rigorously. Practical Implications. According to the results of our study, some variables that are associated with a higher reduction in relapse of opioid use (such as employment and marital status and level of education) cannot be intervened by therapists of substance use disorders but Planning to prescribe sufficient doses of methadone can be effective in reducing relapse of opined use disorder.