Methadone Maintenance in Older Adults: An Exploratory Study

David Sivesind; McWelling Todman; Anna Odom; Randy Seewald; Ranjit Rajaratnam; David Roane; Prameet Singh; Val Bonilla; Jeffrey Ditzell; Dana Novak

David Sivesind
McWelling Todman
Anna Odom
Randy Seewald
Ranjit Rajaratnam
David Roane
Prameet Singh
Val Bonilla
Jeffrey Ditzell
Dana Novak

Abstract

Methadone has been used for the treatment of opioid addictions since the early nineteen-sixties. It is estimated that more than 200,000 individuals take methadone to control their opiate addiction (Blaney & Craig, 1999). Many of those individuals (~20%) have been in opioid-substitute treatment for 10 years or more (SAMHSA, 1994). A review of the literature indicates that relatively little is known about the effects of long term methadone use and its interaction with the physical, psychological and psychosocial aspects of the aging process. However, given the steady aging of the population in general and the methadone maintenance treatment (MMT) population in particular, there is a compelling need for a better understanding of the risks and benefits associated with the extended use of methadone in older adults. Beth Israel Medical Center (BIMC) has an extensive network of MMT clinics. The demographic profile of the clientele suggests that BIMC's clinics serve one of the largest populations of elderly methadone patients in the continental United States. We propose to conduct an exploratory study of BIMC's MMT population in order to document the prevalence of psychiatric, physical and psychosocial co-morbidities in the elderly members of that population (>=55 y/o). By comparing this profile with: (a) the profile of a representative sample of younger MMT patients (18-54 y/o); and (b) published prevalence data from the non-MMT, elderly population, we hope to identify areas of dysfunction and modes of adaptation that appear to be uniquely attributable to the interaction of long term methadone use and aging, and thus possible candidates for further and more extensive study.

References

Anthony, J. C., & Helzer, J. E. (1991). Ed. Robins, L.N & Regier, D.A. Syndromes of drug abuse and dependence. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.

Appel, P. W., & Gordon, N. (1976). Digit-symbol performance in methadone-treated ex-heroin addicts. International Journal of Addictions, 11, 389-401.

Ball, J. C., & Chambers, C. D. (1970). Overview of the problem. In J.C. Ball & C.D. Chambers, eds., The Epidemiology of Opiate Addiction in the United States. Springfield, IL: Charles C Thomas.

Ball, J. C., & Ross, A. (1991). The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag.

Barratt, E. S. (1959). Anxiety and impulsiveness related to psychomotor efficiency. Perceptual and Motor Skills, 9, 191-198.

Blaney, T., & Craig,, R. J. (1999) Methadone maintenance: Does dose determine differences in outcome? Substance Abuse Treatment, 16, 221-228.

Blazer, D., Hybels, C., & Hughes, D. C. (1990). Duke Social Support Index [DSSI]. In: ETS Tests in microfiche collection: 020937.

Brown, A. S. (1974). Satisfying relationships for elderly and their patterns of disengagement. Gerontologist, 14, 258-262.

Capel, W. C., & Stewart, G. T. (1971). The management of drug abuse in aging populations: New Orleans findings. Journal of Drug Issues, 1, 114-21.

Capel, W. C., Goldsmith, B. M., Waddell, K. J., & Stewart, G. T. (1972). The aging narcotic addict: an increasing problem for the next decades. Journal of Gerontology, 27, 102-106.

Cummins, R. A., Eckersley, R., Lo, S. K., Okerstrom, E., Davern, M., & Hunter, B. (2003). Australian Unity Well-being Index: Cummulative Psychometric Record. Australian Centre on Quality of Life. Deakin University. Melbourne, Australia.

Derogatis, L. R. (1997). The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. Journal of Sex and Marital Therapy, 23, 291-304.

Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine, 13, 595-605.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71-75.

Folstein, M., Folstein, S., & McHugh, P. R. (1971). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.

Gordon, N. B. (1976). Reaction-times of methadone treated exheroin addicts. American Journal of Psychiatry, 133, 1337-1340.

Gurnack, A .M, Atkinson, R., & Osgood, N. J. (ed.) (2002). Treating Alcohol and Drug Abuse in the Elderly. New York: Springer Publishing Company.

Hiltunen, A., Lafolie, P. Martel, J. (1995). Subjective and objective symptoms in realtion to plasma methadone concentration methadone patients. Psychopharmacology, 118, 122-126.

Lawton, M. P., & Brody, E. M. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-86.

McCaffery, M., & Pasero, C. (1999). Pain: Clinical Manual. Mosby, Inc.: Wisconsin-Madison. 61.

McLellan, A. T., Kusher, H., Metzger, D., & Peters, R. The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199-213.

Miller, N. S., Belkin, B. M., & Gold, M. S. (1991). Alcohol and drug dependence among the elderly: epidemiology, diagnosis and treatment. Comprehensive Psychiatry, 32, 153-165.

Musselman, D. L. & Kell, M. (1995). Prevalence and improvement in psychopathology in opioid dependent patients participating in methadone maintenance. Journal of Addictive Disease, 14, 67-82.

National Institute on Drug Abuse: Annual Emergency Room Data 1991: Data from the Drug Abuse Warning Network, Series 1, No 11-A, DHHS Publication No (ADM) 92-1955, 1992a.

O'Donnell, J. A. (1969). Narcotic Addicts in Kentucky. Washington, D.C.: U.S. Public Health Service.

Pascarelli, E. F. (1974). Drug dependence: an age-old problem compounded by old age. Geriaterics, 29, 109-115.

Pascarelli, E. F., & Fischer, W. (1974). Drug dependence in the elderly. Journal of Aging and Human Development, 5, 347-356.

Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768-774.

Petersen, D. M. (1988). Substance abuse, criminal behavior & older people. Journal of the American Society on Aging, 12, 63-67.

Petersen, D. M., Whittington, F. J., & Payne, B. P. (ed.) (1979). Drugs and the Elderly. Springfield, IL: Charles C Thomas. Physical Self-Maintenance Scale (PSMS). Self-rated version. Incorporated in the Philadelphia Geriatric Center. Multilevel Assessment Instrument (MAI). Psychopharmacology Bulletin, 24, 795-797.

Sawe, J. (1986). High dose morphine and methadone in cancer patients. Hospital Pharmacokinetics, 11, 87-106.

Spector, I. P., Carey, M. P., & Steinberg, L. (1996). The Sexual Desire Inventory. Development, factor structure, and evidence of reliability. Journal of Sex and Marital Therapy, 22, 175-190.

Strauss, J. S., & Carpenter, W. T (1975). Strauss-Carpenter levels of functioning scale. In: Schutte NS; Malouff JM. (1995). Sourcebook of adult assessment. (Applied clinical psychology). NY: Plenum Press.

Winick, C. (1962). Maturing out of narcotic addiction. Bulletin on Narcotics, 14, 1-7.

Zacny, B. (1995). A review of the effects of opioids on psychomotor and cognitive functioning in humans. Experimental and Hospital Psychopharmacology, 3, 432-466.