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Methadone improves mental health; what’s next?

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methadone improves mental healthGood to see some research from Aberdeen focusing on mental health in patients on methadone and other opiate replacement therapy. Academics in Primary Care conducted a systematic review looking at twenty-two studies where mental health had been assessed at baseline and again at follow up. What did they find?

“Mental health significantly improved for all groups receiving ORT in 14 studies in either some or all of the domains assessed. There was tentative evidence to suggest methadone is less effective at improving mental health than other types of ORT.”

I’m not sure it’s the methadone itself that improves the mental health, it’s not an antidepressant, but more the decreased consequences of active addiction and engagement in moving forward. In any case, it’s good to see evidence that things get better in terms of mental health for many once ORT (opioid substitution therapy) starts. Suboxone might be even more helpful. And things can get better quite quickly. What’s not so clear is what happens in the longer term. There was less evidence that gains were sustained.

Methadone is an evidence based intervention, but it’s a tool. Ideally it should form a part of the recovery journey rather than be the final destination. What happens next, what happens alongside the prescription is vitally important in this regard. With recovery oriented systems of care, many ought to be able to move on.

There is some nice research showing that people in long term recovery report higher scores on wellbeing than the general population norms. It looks like recovery is good for mental health though we need more information on how populations of recovering people do over time. Research suggests that in the first five years, mental health may be lower than the general population. After five years that flips. (The ‘better than well’ research.) The service users in Leeds, interviewed on what they felt was a ‘good outcome’ from treatment identified that things just got better ‘naturally’ with abstinence.

Wouldn’t it also be fascinating to see some British research published looking at mental health in populations in abstinent recovery over time? That would add to the evidence base in a very helpful way.

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    3 Responses to "Methadone improves mental health; what’s next?"
    1. Jo says:

      Yes I can see that if people stick to their methadone and don’t use illicits on top then their mental health would improve and they would be more able to manage and cope with things.

      The other point I wanted to make it that methadone may not be an anti-depressant, but it does have anti-psychotic qualities. Patients with schziphrenia and psychosis from other diagnosis can really struggle when detoxing from methadone and their symptoms of psychosis can get worse. Obviously this is medically managed and its hoped that the patient can stabilise, but sometimes they struggle without the methadone.

      Best Wishes,
      Jo

      • djmac says:

        I’ve certainly seen mental health deteriorate acutely during detox and I think clients need to be warned of the risks if they are contemplating detox< I'd be keying up psychiatric supervision. I'm not sure methadone has particular antipsychotic properties (although I think I saw one paper a while back that argued this), but detox from any substance may lower the psychosis threshold in vulnerable individuals due to the physiological and emotional stress of withdrawal. In any case I'm with you on the need for caution and maximum support. Once more, thanks for commenting, I've appreciated your perspective.

    2. Jo says:

      Your welcome thanks.

      There is considerable data on the use of methadone as an antipsychotic. I remember reading some historical paper about morphine being used as an antipsychotic in the 19th century, and I’ve read other more recent data. I’m not saying that methadone is a front line medication but it does have antipsychotic effect.

      I think its all about detox preparation and having a solid care plan which will support and work with any difficulties.

      Best Wishes
      Jo

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