treatment is most common;^198 however, one
study found that an extended course of
treatment--24 weeks--improves outcomes.^199
Unlike other forms of NRT, patches do not
address the behavior of smoking by occupying
the hands or the mouth or inhaling, but by
passively and slowly delivering the nicotine.^200
A meta-analysis of 24 studies found that the use
of nicotine patches for six to 14 weeks can
nearly double a smoker’s chance of sustaining
abstinence for at least six months compared to
placebos.^201 Unlike nicotine gum, there is little
evidence supporting a connection between
higher doses and higher efficacy rates, or
between longer treatments and better
outcomes.^202 The patch also appears to be
effective regardless of additional psychosocial
interventions.^203 The primary side effect of the
patch is skin sensitivity and irritation.^204
Contrary to the many controlled studies
supporting the efficacy of NRT, a population-
based survey of adult smokers who recently had
quit smoking casts doubt on its effectiveness in
smoking cessation and relapse prevention. In
this study, nearly one-third (30.6 percent) of
smokers who had quit smoking within the
previous two years reported having relapsed,
regardless of whether they used NRT for the
recommended amount of time and regardless of
whether the use of NRT was accompanied by
professional behavioral counseling. While this
study appears to call into question the efficacy
of NRT in achieving smoking cessation in the
general population,^205 it actually underscores the
fact that NRT is not a comprehensive treatment
approach to addiction involving nicotine, but
rather an aid to smoking cessation to be used in
conjunction with other evidence-based acute
care and chronic disease management
approaches.
Methadone. Methadone is a synthetic opioid
used as replacement therapy for patients with
addiction involving opioids.* Methadone
reduces cravings and withdrawal symptoms by
- Methadone can be used in the stabilization, acute
treatment and disease management/maintenance
phases of treatment for patients with addiction
involving opioids.
stimulating opioid receptors in the brain^206 and
reduces the rewarding effects of opioids by
blocking their euphoric effects.^207 Although
methadone is an opioid, it does not produce the
same euphoric rush characteristic of heroin or
oxycodone; its effects are slower and steadier.^208Methadone can be taken orally and has a long
half-life with a slow onset of action.^209
Methadone is safe when used as directed. It
allows individuals with addiction involving
opioids to function relatively normally.^210
Potential side effects of methadone include
drowsiness, weakness, headache and nausea, and
side effects are more likely to occur when
starting methadone, when switching from
another narcotic/opioid medication to
methadone and when the dosage is increased.^211Multiple studies have found that participation in
methadone maintenance treatment (MMT) is
related to significant reductions in patients’ use
of opioids, criminal behavior, injection drug use,
needle sharing and risky sexual behavior which
can increase the risk of HIV and sexually-
transmitted diseases;† MMT also is related to
higher treatment retention rates.^212Methadone does, however, carry the potential
for misuse^213 and the risk of overdose.^214 While
methadone is effective in inhibiting the effects
of opioids like heroin and morphine, it does not
appear to inhibit the effects of alcohol or other
drugs; rather methadone may magnify the
effects of alcohol and other CNS depressants.^215
Its use in concert with other addictive substances
can result in adverse interactions. Methadone
also may accumulate in the body to a toxic level
if it is taken too often, or in larger than
recommended quantities.^216 Because of the risk
of methadone misuse and its consequences,
methadone distribution is regulated by strict
federal and state guidelines.^217 Methadone
prescribed for addiction involving opioids can† Because methadone does not require intravenous
injection, methadone users are less likely to engage in
needle sharing and because they do not need the same
amount of money to obtain heroin, they are less
likely to engage in prostitution compared to their
heroin-using counterparts.