In the 50 years since the discovery of methadone, not much has changed in how physicians prescribe the drug to treat opioid-use disorders from Harlem to Hollis.
START Treatment & Recovery Centers recently played an important role in a University at Buffalo study that looked at how the body metabolizes methadone to determine whether it’s possible to create more individualized, precision prescriptions.
The results of the study led by Dr. Andrew Talal, MD, a professor of medicine at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, looked at genetic and non-genetic differences in how methadone is metabolized in specific patient populations.
The study, Toward precision prescribing for methadone: Determinants of methadone deposition, was published in the April 17th, 2020, issue of PLOS One a peer-reviewed open access scientific journal published by the Public Library of Science.
According to Lawrence S. Brown, Jr., MD, MPH, FACP, DFASAM, CEO of START Treatment & Recovery Centers, who is one of the study’s authors, it is still difficult to predict accurately the correct dosage of methadone. START is a non-profit and New York’s largest independent drug treatment agency, which has treated more than 50,000 New Yorkers since it was founded 50-years ago.
“Determining dosage is a complex process for providers, who typically begin with a low dose that is gradually increased if needed. Too much methadone can be fatal, and too little can cause withdrawal symptoms and lead patients to use heroin to mitigate these symptoms,” says Dr. Brown. “Discovering how different people metabolize methadone is the first step toward personalized medicine that would allow us to determine the optimal dosage based on each person’s characteristics. There is abundant scientific evidence of gender and ethnic differences in many medications. We need to thoroughly investigate population differences in the metabolism of methadone, one of three medications approved by the Food and Drug Administration for opiate use disorder.”
The study of 97 START patients, the majority of whom were either African American or Hispanic, and male, found that gender, body mass index and ethnic background all affect the metabolization of methadone.
The study of 97 START patients, the majority of whom were either African American or Hispanic, and male, found that gender, body mass index and ethnic background all affect the metabolization of methadone. It also found that a specific genotype of the liver enzyme responsible for metabolizing methadone and other substances has a direct effect on whether a person metabolizes methadone quickly or slowly.
According to Dr. Brown, the next step will be conducting larger studies in more racially and ethnically diverse patient populations. The goal is to develop an algorithm that will help physicians determine the correct dose of methadone based on each individual patient.
The ability to make methadone dosages more precise though personalized medicine will help patients better control symptoms and reduce the number of death due to opioid overdoses.
START has treated over 50,000 New Yorkers throughout Brooklyn, Manhattan and the Bronx since it was founded in 1969.
START has treated over 50,000 New Yorkers throughout Brooklyn, Manhattan and the Bronx since it was founded in 1969. Its goal is to provide the highest quality of compassionate, comprehensive, evidence-based healthcare and social services; education of the public concerning the maintenance of healthy lifestyles; and cutting-edge behavioral, biomedical, and healthcare services research.
Its community-based treatment programs for adults and adolescents use individual and group counseling with medical and behavioral health professionals to treat patients; some of its clinics offer short-term, outpatient detoxification and a drug-free chemical dependency program for other non-opiate addictions. Its outpatient services and programs for people seeking quality treatment for drug addiction and rehabilitation include comprehensive medical care and specialized HIV services; behavioral health and vocational services; and medical case management.
For more information, visit www.startny.org.