**2. Study design**

statistics show that heroin is the most commonly used illicit opioid in Europe, but synthetic opioids such as methadone, buprenorphine, and fentanyl are also misused. The average prevalence of high-risk opioid use among general EU population (15–64 years) is estimated at

In addition, opioids remain major drugs of potential harm and health consequences. There are several complications, which are derived from the illicit opioids consumption, among which there are overdoses, transmissible infections, the increase of criminality, reduction of

The addiction to opioids, a complex disease, necessitates a long-term treatment, which mainly consists in the substitution therapy, also called, according to WHO, "agonist pharmacotherapy," "agonist replacement therapy" or "agonist-assisted therapy"; this is a key component of the treatment resources [5]. WHO defines it as the administration under medical supervision of prescription psychoactive substances, which are pharmacologically related to the one pro-

Several tries of substitution treatments of the opiates addiction took place at the beginning of the twentieth century and they used the morphine. The morphine did not prove to be a corresponding substance for substitution (tolerance used to rapidly install, the patient needed to have several injections per day). Since 1960s, starting with the discovery of the methadone,

In 2005, WHO added methadone and buprenorphine in the list of essential drugs for the treatment of opioid dependence [6]. This decision was based on numerous studies that have shown that using these two drugs in substitution therapy bring benefits for physical and mental health, improves quality of life, and reduces injection behaviors associated with high risks. Therefore, international guidelines recommend methadone and buprenorphine as first-line medication treatment for opioid dependence [7]. The studies were conducted in countries with different socio-economic conditions and different treatment systems for drug addiction. These studies have shown that therapy with methadone or buprenorphine is safe and effective [5]. The substitution therapy with methadone or buprenorphine gives addicted people the possibility to function normally within their families, jobs, and communities [8]. However, methadone was shown to have higher treatment retention rates than buprenorphine-naloxone, and it is preferred over buprenorphine-naloxone for patients at higher risk of treatment dropout [9]. A standard terminology for the treatment with methadone, classified into four categories, has

Usually, the term "substitution therapy" is utilized as an equivalent to "substitution mainte-

ducing dependence, to people with addiction, for achieving defined treatment goals.

0.4%, the equivalent of 1.3 million high-risk opioid users in Europe in 2015 [1].

workforce, and general life quality [3, 4].

118 Drug Addiction

the substitution treatment began to be reevaluated.

• Short-term detoxification: decreasing doses for up to 1 month;

• Short-term maintenance: stable doses for up to 6 months;

• Long-term maintenance: stable dose for more than 6 months.

• Long-term detoxification: decreasing doses over more than 1 month;

been proposed:

nance therapy" [10].

The group to be studied consisted of 82 drug addicts, consumers of heroin; these patients were examined from the psychological point of view at the Addiction Section, were hospitalized and monitored during the detoxification which was carried inpatient, under strict medical supervision, for a period of 10–14 days, then in the outpatient treatment (methadone substitution treatment). The study was approved by the Ethical Committees of the Centre and the informed consent for the participation in the study was obtained from all patients.

**4. Results and discussions**

*4.1.1. Indicator: sex*

*4.1.2. Indicator: age*

tion of 10.71 males/females.

Anova Test was applied (p < 0.001).

We have taken a group of 82 patients, both males and females, aged between 19 and 47, living in Bucharest and diagnosed with heroin addiction (according to ICD-10), who came voluntarily to get a substitute treatment with methadone in a center of specialized treatment of addiction, placed in Bucharest. The group under study has been described in details, taking into account the demographic, addiction characteristics and comorbidity, the history of the heroin consumption, the history of the treatment, the clinical and laboratory evaluation.

Methadone Treatment for Heroin Dependence http://dx.doi.org/10.5772/intechopen.78066 121

The complex description of the patients group regarding the demographic, addiction, and

In the selected group, males are predominant; so, the group has included 75/82 patients, respectively 91.5% and 7/82 patients, respectively 8.5% females (**Table 2**), leading to a propor-

In the general hypothesis of the study, we have anticipated that, when speaking about the drug consumers, there are clear differences between the average age of the drug consumers who are registered and the onset average age of the drug consumers within the same population, and the results lead to the confirmation and acceptance of the general hypothesis.

Thus, the average age of the patients registered at the beginning of the study was 31.28 ± 5.15 years and varied between 19 and 47 years (**Figure 1**), being significantly higher than the average age at the onset of drug use, which was 19.52 ± 4.35 years and varied between 11 and 33 years (**Figure 2**) (p < 0.001, t-Student). The statistic significant difference was also noticed when the

As regards the age at the onset of heroin use, there is a dramatic remark which says that many of the patients declared their onset under the age of 20, respectively, the most frequent interval, between the age of 15 and 20 (40/82 patients, 48.8%). The study points out the growth of the drug consumption among young people and the decrease of the onset age. Thus, the history of the opiates consumption is a long term one, an average of 11.73 ± 4.52 years varies between 3 and 25 years (**Figure 3**). We have pursued, on the other hand, the duration of the drug consumption, previous to the first requirement of treatment. The obtained results, using some specific statistic methods, have shown that the total period of the drug consumption is significantly different, from the statistic point of view (p < 0.001; t-Student, ANOVA**),** from the period of the drug consumption until the first methadone substitution treatment, with an age

average 6.51 ± 3.45 years, varying in the area 1–18 years (**Figure 4**).

**4.1. Demographic, addiction characteristics, and comorbidities**

treatment characteristics, as well as comorbidities is presented in the **Table 1**.

The study group was characterized in detail, taking into account demographic, comorbid and addiction characteristics, heroin use history, treatment history, and clinical and paraclinical evaluation.

Indicators/parameters to be followed: age; sex; occupation; comorbidity; the history of heroin consumption (detailed as follows: recognized consumption age, intravenous heroin consumption starting age, way of heroin administration, other tested/consumed drugs); history of treatment (previous abstinence periods, previous hospitalizations, previous treatments, when starting treatment with methadone, which is currently under, psychological counseling; methadone dose); and toxicological analytic screening aiming at both diagnosing the drug consumption as well as checking and confirming the abstinence along the period of substitution therapy with methadone.

During the hospitalization, the psychological investigation of the patients was made. The description of the mental state, together with monitoring the behavior during the psychological interview, aim at filling in the examination file and applying efficiency and personality tests for the psycho-diagnostic purpose.

Qualitative analytical screening and quantitative assays refers to the immunofluorescence method for the quantitative determination of heroin and their metabolites in urine [19]; it is based on a technique of fluorescence polarization immunoassay using an automatic drug analyzer version TDxFLx (Abbott Laboratories). The results can be expressed either in qualitative (presence or absence of opiates) or quantitative (sample concentration in ng/mL) terms. Detection threshold (cut-off) was established at 200 ng/mL (this being the most widely accepted value). Measurements obtained are used for the diagnosis of heroin use and for establishing the substitution therapy.
