a Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b Center for Behavior and Health, Department of Psychiatry and Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Int Rev Psychiatry. 2018 Oct;30(5):147-154. doi: 10.1080/09540261.2018.1509843. Epub 2018 Nov 6.
Methadone maintenance treatment (MMT) is an important treatment tool for the opioid epidemic. One challenge is that many persons who present for MMT also have co-occurring psychiatric disorders. Individually, both methadone and psychiatric medications carry risk of weight gain. Therefore, concurrent prescribing of methadone and psychiatric medications places dual diagnosis patients at even greater risk. As a parallel obesity epidemic grows, results from clinical trials assessing weight gain and weight management strategies among MMT and psychiatric patients can both inform and guide clinical practice. This study reviews findings from a literature search for recent clinical trials that focused on weight gain and weight management strategies during MMT with concurrent psychotropic medication use. While several studies have documented weight gain during MMT and psychotropic medication treatment, this study failed to identify recent work that explored concurrent prescribing. Most weight management strategies involved the use of additional medications and available data suggests that MMT and concurrent use of psychotropic medications increases the risk for obesity. More robust research is needed on weight gain and potential mitigation strategies when these treatment modalities are jointly utilized. Clarification of underlying biological mechanisms and development of non-pharmacological interventions merit further consideration.
美沙酮维持治疗（MMT）是应对阿片类药物流行的重要治疗手段之一。然而，许多前来接受 MMT 的患者同时伴有共病性精神障碍。美沙酮和精神科药物单独使用都会增加体重，因此，同时开具美沙酮和精神科药物会使双重诊断患者面临更大的风险。随着肥胖症的流行，评估 MMT 和精神科患者体重增加和体重管理策略的临床试验结果既可以为临床实践提供信息，也可以为其提供指导。本研究回顾了近期专注于 MMT 期间同时使用精神药物时体重增加和体重管理策略的临床试验文献检索结果。虽然有几项研究记录了 MMT 和精神科药物治疗期间的体重增加，但本研究未能确定最近探索同时开处方的研究。大多数体重管理策略涉及额外药物的使用，现有数据表明 MMT 和同时使用精神药物会增加肥胖的风险。当这些治疗方式联合使用时，需要对体重增加和潜在缓解策略进行更深入的研究。阐明潜在的生物学机制并开发非药物干预措施值得进一步考虑。
