Comparison of the effects of methadone and buprenorphine maintenance treatments on cognitive functions, the role of dose modulation

Dissertation for Master's Degree

General Psychology

Abstract

The aim of this research is to compare methadone and buprenorphine maintenance treatments on cognitive functions by investigating the role of dosage modifier. The research design is causal-comparative. The statistical population of this study includes 156 drug abusers who underwent maintenance treatment with methadone and buprenorphine in eight drug abuse treatment centers in Semnan in 1992-1993. The inclusion criteria included a history of opium and syrup drug abuse, being male, not having serious psychiatric disorders, age 18-50 years, not having an IQ lower than 85 in the adult Wechsler verbal subtests. The participants in methadone (95 people) and buprenorphine (61 people) treatment groups performed working memory, verbal memory, visual memory and attention test (go/no go). Data were analyzed with multivariate analysis of variance model. The findings showed that the group treated with buprenorphine is superior to the group treated with methadone in terms of working memory and verbal memory. In this way, it can be concluded that buprenorphine drug is more effective on cognitive functions compared to methadone.

Key words: methadone, buprenorphine, cognitive functions.

Introduction

Addiction is a chronic and progressive disease with characteristics such as compulsive behaviors, uncontrollable temptations, substance-seeking behaviors, and its continuous use despite its harmful social, psychological, physical, family, and economic consequences. which brings with it, is determined. Today, the issue of drug abuse and addiction is a serious concern of various societies, especially developing countries, where not much action has been taken in this regard. All addiction experts and experts agree on the point that drug abuse cannot be considered only as an individual, physical or social problem, but it should be considered as one of the most obvious biological-psychological-social problems that can easily weaken the foundation of the individual, family, social and cultural life of an individual and society and expose it to collapse (Robinson [1] and Bridge [2], 2003). Considering the increasing growth of addiction in different countries, the need for more appropriate treatment of this disease is felt more. Adults who use drugs often have poor thinking, memory and attention. As a result of substance abuse, they have inappropriate social behaviors and their job efficiency and personal communication are weak (Mommatazi, Jafari, Khosravi and Vanik Farjam, 2013). Addiction treatment is one of the areas that has been receiving the attention of researchers and clinicians for a long time, and since this disorder has an important link with many different psychiatric and psychological disorders, providing specific treatments in addition to helping to reduce the incidence and persistence of this disorder can also help in the treatment of other disorders. In this case, the review of the conducted research shows that the interventions used in the treatment of addiction have been effective not only in the treatment of this disease but also in the case of other chronic disorders similar to addiction, such as cardiovascular diseases and diabetes, especially that these treatments have been used on a case-by-case basis in such a way that they focus on the pathological symptoms that the patient presents during the initial interview (Leshner, 1999; quoted by Azhadadi, Rostami, Rahiminejad and Akbari, 1390). Therefore, in recent years, drug treatment methods such as methadone [3] and buprenorphine [4] substitution treatment are being implemented in the country and in a systematic way. Drug substitution treatment for drug addicts keeps patients in treatment and reduces illegal drug abuse and crime. As a result, the World Health Organization has mentioned that this treatment should be available to drug abusing patients worldwide (Repili, Fabritos, Kaleska and Alho, 2009). In addition, in the past programs to stop drug addicts, there was an emphasis on hospitalization of patients. But currently, the emphasis is on replacement therapy and on an outpatient basis (McLellan, Arendt and Metzger, 1993; Vollmer and Korot, 2001; Wichen, Sabin, Applet, Beckmond, Goles et al., 2005).In substitution therapy, the primary goal is not to stop using drugs, but to reduce the risks and harms associated with drug addiction. Also, breaking the vicious cycle of drug use and criminal acts related to drugs. which includes continuous medical treatment and doctors will have better opportunities to treat mental and physical diseases such as hepatitis and AIDS, etc. The long-term goal is to stop drug use in patients completely (Wichen et al., 2005). There are currently two main types of drugs available in alternative therapy. Treatment with methadone [5] and buprenorphine [6] is one of the drug treatment methods that helps addicts to control their drug addiction (Ling, Charostra, Kim, and Kelt, 1976; Leeson-Wolf, Goody, and Small, 2002; Matic, Breen, Kimber, and Davioli, 2004; Poser, Poser and Medicine, 1996; Sun, Kimi, Perry, Mata, and Perta, 1990; Soyka, Benzer, Buchberger, and Nabar, 1997; Wall and Haga, 2003). Methadone is a synthetic opioid and Mu receptor agonist (µ) with a longer lifetime than other opiates (such as heroin) that a daily oral dose prevents the onset of opiate withdrawal symptoms for 24 hours or more. It is produced in a laboratory and prescribed as a form of treatment for opioid dependence. Methadone reduces the euphoric effects of other opioids, without necessarily causing euphoria, relief, or pain relief (Kahnock, Juarez-Garcia, Jewitt, Frio, Liu et al., 2007; Petichen, Stoehler, DeGlon, Liotti, Waldogro et al., 2001). Consumption by clients is reduced. In many studies, the effectiveness of this treatment has been shown to varying degrees in relation to psychological support and psychological treatment of drug-dependent patients (Ling et al., 1976; Sun et al., 1990; Poser et al., 1996; Suika et al., 1997; Leeson-Wolf et al., 2002; Wall and Haga, 2003; Matic et al., 2004; Vichen et al., 2005). Maintenance treatment with methadone [7] is effective in improving mental and physical health, social functioning, and improving quality of life (Mashshari, 2011; Rohani, Salarieh, Abedi, and Khairkhah, 2011; Demeyer, Vanderplappgen Lammertin, Van Nieuwesen, Sabi et al., 2011). Opioid dependents gain access to stable substitution from an authorized substance through methadone maintenance treatment. As a result, people who are being treated are temporarily freed from the constant stress of using illegal opioids, which is often associated with criminal activities and dangerous sexual and injecting activities. By using this type of treatment, instead of experiencing a constant cycle of mood swings, a person achieves relatively stable mood states (Kan Nak et al., 2007).

In general, research indicates that people undergoing maintenance treatment with methadone spend less time using drugs daily. The use of illegal opioids is reduced. This pattern continues as long as people are being treated. The use of other substances such as cocaine, marijuana and alcohol is also reduced. They spend less time on criminal activities. They spend less time trading materials. They spend less time in prison. The death rate is lower than people who are not treated. The death rate for people who are not treated is 3 times higher than those who are treated. Injections and related risky behaviors are reduced. The reduction of HIV infection is more in them. They are more likely to improve social functioning and have a full-time job (Ward, Matt and Hall, 1992; Novick, Joseph and Croxon, 1990; Ball and Ross, 1991).

Buprenorphine, like methadone, has been shown to be an effective treatment. Buprenorphine is a partial agonist of mu receptor [8] and a strong antagonist of kappa receptor [9]. Partial agonists of the Mu receptor bind to the Mu receptor and activate it, but this activation occurs less than full agonists. In the sense that despite being an opioid and having specific side effects of opioids such as euphoria and weakening of the respiratory system, its maximum effect is less than full opioid agonists such as heroin and methadone (Vichen et al., 2005; Kaku et al., 2003; Gira et al., 2004; Kannak et al., 2007). Due to its high affinity to the mu receptor, it competes with other opioids and blocks their effects, causing morphine, methadone, and other opioids to separate from the receptor. For this reason, it causes withdrawal symptoms in patients who have morphine in their body.