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Using Biological Tools to Assess Methadone Treatment

Student thesis: Doctoral ThesisDoctor of Philosophy

Basma Tarek Alharthy

Methadone is acknowledged as an effective pharmacological substitution treatment for heroin dependence. However, patients presenting to addiction treatment services usually have multiple substance use, mental and physical health and social problems. Excessive alcohol use in individuals receiving methadone substitute maintenance treatment is a well-established clinical problem, which creates a treatment challenge. The research addressing the management of this group of patients is limited.
There were three key studies in this thesis. The first study investigated the measurement of methadone and EDDP in the urine samples of 60 patients, calculated the EDDP:methadone ratio, and explored whether it could be used effectively as an index of methadone metabolism among clients receiving methadone substitution treatment. The results indicated a correlation between methadone and EDDP concentrations and methadone dose; however, EDDP:methadone ratio exhibited a high inter- and intra-individual variability, which hindered the possibility of using it as a sensitive objective biomarker for monitoring compliance among patients receiving methadone. Part of the study examines whether this ratio is altered by the consumption of alcohol in a problematic manner by this group of patients. A small study also examined three patients during methadone induction, and examined EDDP and methadone ratio. A further study explored the effectiveness of using the alcohol biomarkers ethyl glucoronide (EtG) and ethyl sulphate (EtS) to screen for recent alcohol consumption in 60 patients (138 urine samples) collecting their daily methadone dose. The results indicated that the EtG and EtS were sensitive biomarkers to detect alcohol use in the past 24 hours or more and therefore it would be a useful tool to incorporate during methadone treatment especially coupled with knowledge of patients’ co-dependence. The final study investigated the use of the breathalyser test in 23 patients who were screened for alcohol use before the prescription of methadone. Results found that breathalysers were successful in detecting alcohol use but for a much shorter timeframe than new recent alcohol biomarkers, which could offer a more specific and sensitive alternative.
Original languageEnglish
Awarding Institution
Award date2015


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