Issue link: https://maltatoday.uberflip.com/i/1275149
maltatoday | SUNDAY • 2 AUGUST 2020 9 NEWS JAMES DEBONO THE blanket ban of methadone treatment in residential reha- bilitation programmes may be depriving addicts of making use of cognitive skills which may be vital in their progress from ad- diction, an authoritative study published in the Malta Medical Journal shows. Methadone is an opioid used for in the treatment of addicts, which allows them to avoid the uncomfortable withdraw- al symptoms that result from complete abstinence. The study sustains the view that methadone treatment re- sults in an improvement in 'cognitive functions' among opioid addicts in vital matters like the ability to take deci- sions, orient oneself, control body movements and plan ahead. The study concludes that methadone treatment contrib- utes positively to public health by "ensuring compliance of opioid dependent individuals to their treatment plan with fewer relapse rates and a de- crease in risky behaviour". Impaired cognitive functions like visuospatial skills can re- sult in, for example, poor driv- ing ability because distances are not judged correctly or re- sult in a difficulty navigating in space such as bumping into things. These skills improve among addicts undergoing methadone treatment. Executive functions are also improved as a result of meth- adone treatment. Impaired executive functions result in forgetting to complete tasks, an inability to keep track of personal items like keys and cell phones, trouble following conversations, losing train of thought, a difficulty remem- bering steps in a multi-step processes and an inability to remember names. Participants who had stopped methadone were significant- ly impaired in most aspects of cognition tested apart when compared to healthy controls. Participants on methadone did not significantly differ in the other areas of cognition when compared to controls. The study involves an assess- ment of cognitive functions of three groups of participants: 22 former opioid dependents receiving methadone mainte- nance treatment, 21 former opioid dependents withdrawn from all opiates and 22 healthy controls without a history of il- licit substance dependence. The study sustains the view that individuals with opioid de- pendency who undergo meth- adone treatment seem to ex- hibit better cognitive function compared to those who under- went complete detoxification, "at least partially explaining the superiority of methadone maintenance treatment (MMT) over interventions with a drug- free ideology". After two months of MMT, improvements in verbal learn- ing and memory, visuospatial memory, and psychomotor speed, were recorded in a sam- ple of persons with heroin ad- diction. Unfortunately, according to the authors of the study, the integration of MMT in ther- apeutic communities is not mainstream, despite reported effectiveness. "The impact of an interven- tion with documented harm reduction benefits such as MMT on cognitive function is paramount, especially when one takes an overall view of the process of recovery which warrants the mobilisation of cognitive skills to confront the various individual challenges to re-establish a meaningful existence." But despite the effectiveness of MMT, individuals who are on methadone are "frequently stigmatised and encouraged to come off methadone at a stage when risk of relapse is still sig- nificant." The study questions the "blanket approach" which ex- pected those planning to join a residential drug rehabilita- tion programme to stop taking methadone. "For some, methadone de- toxification prior to rehab not only lowers their ability to cope with the challenges of the pro- gramme due to a possible dete- rioration in executive function, but exposes them to associated risks". The study is authored by Kristian Sant, a specialist in psychiatry, mental health and addiction services, at Mt Car- mel Hospital, and by Anthony Dimech and Aloisia Camilleri, consultant psychiatrists in gen- eral adult and addiction servic- es, at Mt Carmel Hospital. Individuals on methadone are "frequently stigmatised and encouraged to come off methadone at a stage when risk of relapse is still significant" Stigma on methadone is wrong, doctors say Authoritative study shows that addicts undergoing methadone treatment perform better in daily cognitive functions like orientating themselves and planning ahead, than addicts who abruptly stop taking any opioids