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What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients

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  • Angelo G.I. Maremmani

    (Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy
    Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy
    G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy)

  • Matteo Pacini

    (G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy)

  • Icro Maremmani

    (Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy
    G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy
    V.P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56126 Pisa, Italy)

Abstract

Mental Disorders and Heroin Use Disorder (HUD) often co-occur and constitute correlated risk factors that the authors believe are best considered from a unitary perspective. In this article we review and discuss data collected by the V.P. Dole Research Group in Dual Disorder (V.P. Dole DD-RG) patients according to the following six discussion points: (1) Treatment of personality disorders during Methadone Maintenance Treatment (MMT); (2) Treatment of Mood Disorders during MMT; (3) Treatment of Anxiety Disorders during MMT; (4) Treatment of Psychotic Disorders during MMT; (5) Treatment of violence during MMT; (6) Treatment of Alcohol Use Disorder (AUD) during MMT. In treating Mood Disorder in HUD patients, we must bear in mind the interactions (potentiation and side effects) between psychopharmacology, used substances and agonist opioid medications; the use of psychiatric medications as an anti-craving drug, and the possible use of agonist and antagonist opioid medications in treating the other mental disorders. In treating chronic psychosis in HUD patients, we must consider the potentiation and side effects of antipsychotic drugs consequent on HUD treatment, worsening addiction hypophoria and inducing a more severe reward deficiency syndrome (RDS) in hypophoric patients. Violence and AUD during MMT can benefit from adequate dosages of methadone and co-medication with Sodium gamma-hydroxybutyrate (GHB). The experience of our V.P. Dole DD-RG suggests the following: (a) DD is the new paradigm in neuroscience in deepening our understanding of mental health; (b) To successfully treat DD patients a double competence is needed; (c) In managing DD patients priority must be given to Substance Use Disorder (SUD) treatment (stabilizing patients); (d) Antidepressant use is ancillary to SUD treatment; antipsychotic use must be restricted to acute phases; mood stabilizers must be preferred; any use of Benzodiazepines (BDZs) must be avoided.

Suggested Citation

  • Angelo G.I. Maremmani & Matteo Pacini & Icro Maremmani, 2019. "What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients," IJERPH, MDPI, vol. 16(3), pages 1-26, February.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:3:p:447-:d:203253
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    References listed on IDEAS

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    1. Deykin, E.Y. & Levy, J.C. & Wells, V., 1987. "Adolescent depression, alcohol and drug abuse," American Journal of Public Health, American Public Health Association, vol. 77(2), pages 178-182.
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    1. Ashim Gupta & Abdalla Bowirrat & Luis Llanos Gomez & David Baron & Igor Elman & John Giordano & Rehan Jalali & Rajendra D. Badgaiyan & Edward J. Modestino & Mark S. Gold & Eric R. Braverman & Anish Ba, 2022. "Hypothesizing in the Face of the Opioid Crisis Coupling Genetic Addiction Risk Severity (GARS) Testing with Electrotherapeutic Nonopioid Modalities Such as H-Wave Could Attenuate Both Pain and Hedonic," IJERPH, MDPI, vol. 19(1), pages 1-12, January.
    2. Morgane Guillou-Landreat & Antoine Dany & Gaëlle Challet-Bouju & Edouard Laforgue & Juliette Leboucher & Jean Benoit Hardouin & Caroline Victorri-Vigneau & Marie Grall-Bronnec, 2021. "What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report," IJERPH, MDPI, vol. 18(4), pages 1-7, February.

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