title: Achievement of take-home dose privileges is associated with better-perceived sleep and with cognitive status among methadone maintenance treatment patients.
abstract: OBJECTIVE
  Methadone maintenance treatment (MMT) patients may achieve up to a 2-week privilege of methadone take-home doses (THD), which is associated with considerable responsibility. MMT patients are characterized as having poor sleep quality and low cognitive states. We studied sleep indices and cognitive status with respect to THD privileges.
  
  
  METHODS
  A sample of 123 MMT patients stratified by THD groups was studied. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the cognitive Clock Drawing Test (CDT) were performed.
  
  
  RESULTS
  Thirty-one of 123 patients never had any THD and 92 did (25 had the maximum of 2 weeks). The never THD had history of longer duration of opiate usage and a shorter period in MMT. They had the highest rates of poor sleep (80.6%, PSQI > 5), daily sleepiness ("fall asleep while talking") (41.9%), and impaired cognitive status (58.1%, CDT < 3), while those who had 2-week privileges had the lowest (56, 8, and 28%, respectively). Logistic regression characterized THD patients as no-benzodiazepine and no-cocaine, short opiate usage duration, low ADHD scores, and no cognitive impairment (CDT = 3) and its interaction with treatment duration.
  
  
  CONCLUSIONS
  Privileges that reflect patients' abstinence and rehabilitation were also expanded to be associated with better cognitive states. These finding confirm the THD dispensing performance. Including CDT as part of the decision for dispensing THD may be considered.
authors.affiliation: Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.
authors.forename: Einat
authors.initials: E
authors.lastname: Peles
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
authors.forename: Yoav
authors.initials: Y
authors.lastname: Domany
authors.forename: Anat
authors.initials: A
authors.lastname: Sason
authors.forename: Oren
authors.initials: O
authors.lastname: Tene
authors.forename: Miriam
authors.initials: M
authors.lastname: Adelson
mesh_terms: D059350:Chronic Pain / Q000523:psychology; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000523:psychology; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012737:Sex Factors; D012890:Sleep; D014851:Wakefulness
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Clock Drawing Test; cognitive; methadone maintenance treatment; sleep; take-home dose privileges