Enhanced sensitivity to methadone in adult rats perinatally exposed to methadone

Adult rats, maternally exposed to methadone during gestation and/or lactation, were evaluated for thermoregulatory and nociceptive responsiveness following a challenge with 5 mg/kg (i.p.) methadone. Prior to drug administration, female rats in the gestation and gestation-lactation groups and all male rats perinatally exposed to methadone were subnormal in body temperature. One hour after acute methadone injection, male control rats were hypothermic. All groups of methadone-treated offspring exhibited a marked lowering in body temperature with respect to their pre-injection levels, as well as in regard to values of methadone-administered control animals. Prior to drug administration, male rats of the gestation-lactation group and female rats of the gestation and lactation groups had elevated nociceptive thresholds. Except for male rats in the lactation group, animals treated with methadone perinatally had longer latencies in response to the hot-plate relative to their pre-injection values, as well as to levels of methadone-injected controls. Three days after acute methadone administration, some groups of rats subjected to this drug during gestation and/or lactation were found to be hypothermic and hypalgesic in respect to their pre-injection values, and also relative to control rats. These results suggest that exposure to methadone early in life can have a profound influence on drug response in adulthood.     

Enhanced development of dispositional tolerance to methadone by desipramine given together with methadone

Rats given 2-day oral administration of methadone (15 mg/kg, twice on day 1 and once on day 2) by gastric tube developed dispositional tolerance to methadone analgesia as demonstrated by a decrease in analgesic response and by an increase in methadone metabolism. The increased metabolism of methadone was evidenced by a decrease in brain concentration of 14C-methadone and increases in the percentages of total 14C in liver or urine as 14C-water-soluble metabolites (14C-WSM) after the rats were challenged with a test dose of 14C-methadone. Two-day pretreatment with a combination of desipramine (DMI) (10 mg/kg, ip) and methadone (15 mg/kg, po) enhanced the development of dispositional tolerance to methadone analgesia which was evidenced by a greater decrease in the brain concentration of methadone and a greater increase in methadone metabolism as compared to those changes in rats pretreated with only methadone. Repeated treatment with DMI alone neither decreased the analgesic effect of methadone nor stimulated methadone metabolism. It is suggested that DMI given together with methadone promoted the induction of methadone metabolism in the liver by prolonging the enzyme-stimulating state of methadone, thus enhancing the development of dispositional tolerance to methadone.     

Excretion of methadone in semen from methadone addicts; Comparison with blood levels

The concentration of methadone was measured in the semen of seven methadone maintenance subjects and compared with the concentration of the drug in blood. The daily dose of methadone in these subjects ranged between 20 and 80 mg and was administered by mouth in the local methadone clinic in the usual manner. Samples of blood and semen were obtained from each subject one to four hours after dosage. The concentration of methadone in the blood ranged between 59 and 126 ng/ml in six of the volunteers. The concentration of methadone in semen ranged between 73 and 420 ng/ml in the seven subjects. The ratio of the concentration of the drug in semen to the concentration in blood ranged from 0.82 to 4.72. Methadone is excreted in small amounts in human semen and is transmitted from male to female during sexual intercourse.     

Impaired glucose metabolism in heroin and methadone users

Plasma glucose and insulin responses to both oral and intravenous glucose stimulation were evaluated in heroin and methadone addicts, compared to healthy control subjects. Both groups of addicts had an altered response to oral and intravenous glucose load. These phenomena were linked to a reduced insulin response. Moreover, increased fasting insulin levels in both groups of addicts were observed. These data show that both heroin and methadone addiction may alter glucose metabolism, and, furthermore, stress the findings of similarities between opiate addicts and non-insulin dependent diabetics.     

Method for determination of methadone in exhaled breath collected from subjects undergoing methadone maintenance treatment

At present drugs of abuse testing using exhaled breath as specimen is only possible for alcohol. However, we recently discovered that using modern liquid chromatography–mass spectrometry technique amphetamine and methamphetamine is detectable in exhaled breath following intake in drug addicts. We therefore undertook to develop a method for determination of methadone in exhaled breath from patients undergoing methadone maintenance treatment. Exhaled breath was collected from 13 patients after intake of the daily methadone dose. The compounds were trapped by filtering the air through a C18 modified silica surface. After elution of any trapped methadone the extract was analysed by a combined liquid chromatography–tandem mass spectrometry method. Recovery of trapped methadone from the filter surface was 96%, no significant matrix effect was observed, and the quantification using methadone-d3 as an internal standard was accurate (<10% bias) and precise (coefficient of variation 1.6–2.0%). Methadone was indisputably identified by means of the mass spectrometry technique in exhaled breath samples from all 13 patients. Identification was based on monitoring two product ions in selected reaction monitoring mode with correct relative ratio (±20%) and correct retention time. Excretion rates ranged from 0.39 to 78 ng/min. No methadone was detected in 10 control subjects. This finding confirms that breath testing is a new possibility for drugs of abuse testing. Collection of exhaled breath specimen is likely to be more convenient and safe as compared to other matrices presently in use.     

Effect of methadone on TSH and thyroid hormone secretion

The hypothalamus-pituitary-thyroid function was studied in 15 male patients on chronic methadone treatment (40 mg/day). No significant variations of TSH, T4, T3 and rT3 levels were documented, either in basal conditions or after TRH stimulation; however a reduced TSH pituitary response was recorded in some patients (6 out of 15).     

When is coercive methadone therapy justified?

Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost‐effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such ‘MMT offers’ on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non‐consensual. We argue that non‐consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non‐consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.     

Stereoselective disposition of methadone in man.

Stable isotope labeled methadone (pentadeuteromethadone) has been used in conjunction with gas chromatography-chemical ionization mass spectrometry to study plasma disappearance rates and urinary excretion of pharmacologically active R-(?)-methadone (l-methadone) and inactive S-(+)-methadone (d-methadone) in three adult methadone maintenance patients. In all three cases, the analgesically active enantiomeric form of the drug had a significantly longer elimination half-life ($\text{t}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>\beta </mtext>}}$) when studied in a steady state than did the inactive form ($\text{t}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>\beta </mtext>}}$ for active R-(?)-methadone, 51.7 to 61.8 hours; $\text{t}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>\beta </mtext>}}$ for inactive S-(+)-methadone, 31.8 to 37.0 hours). The ratio of drug elimination half-lives } R-(?)-/S-(+)- ranged between 1.40 and 1.94. In the two cases so studied, slower plasma disappearance of active R-(?)-enatiomer than the inactive S-(+)-enantiomer was also observed ($\text{t}{}_{\mathrm{<mtext>1</mtext><mtext>2\beta </mtext>}}$ R-(?)-, 42.8 and 52.5 hours; $\text{t}{}_{\mathrm{<mtext>1</mtext><mtext>2\beta </mtext>}}$ S-(+)-, 38.3 and 41.3 hours).