1. Methadone is a regulated medication that is effective in treating opioid use disorder; however, diversion of take-home methadone can occur and is difficult to detect.
2. One method of detection may be to utilize a handheld spectrophotometric assay to detect doses of methadone that may have been altered by the patient.
Evidence Rating Level: 2 (Good)
Opioid use disorder is a condition which may be treated with a variety of medications, including methadone. However, there is a risk of diversion, defined as patients selling or giving away their methadone to others. Methadone has a narrow margin of safety and the potential for dangerous results such as overdose on diverted methadone exists. The purpose of this study was to determine whether a low-cost ultraviolet (UV) light spectrometer could be used to determine if methadone doses were altered at home, which could potentially detect instances of diversion.
This study used methadone liquid concentrate obtained by several suppliers, with the largest being Roxane Laboratories (Columbus, Ohio, United States), with the study being conducted in South Burlington, Vermont, United States. 10 methadone doses were prepared as controls to determine confidence intervals. These doses were compared to 104 random bottles obtained over a 10 month period, followed by an additional 103 bottles with concern for diversion from 27 patients collected over an additional 14 month period. UV-visible spectrophotometry was then performed on these samples, and methadone concentrations were recorded.
The results demonstrated that spectrophotometry may be a viable method to determine whether diversion had occurred. Out of the bottles with concern for diversion, 15 had <25% and 8 had <75% of the expected concentration. However, this study did note limitations of the spectrophotometry assay, such as the expense of the instrumentation, and the requirement for clinical staff to become acquainted with performing the intrinsic steps necessary for operation of the instrumentation. Despite these limitations, this pilot study suggests that spectrophotometry may be an easy, low-cost way of determining some instances of methadone diversion.
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