International Presentations: Risks of an Inadequate Methadone Maintenance Protocol


  • Icro Maremmani, MD, Santa Chiara University Hospital, University of Pisa, Pisa, Italy
  • Angelo Giovanni Icro Maremmani, MD, School of Psychiatry, University of Pisa, Italy
  • Matteo Pacini, MD, G. De Lisio Institute of Behavioural Sciences, Pisa, Italy

Alcohol Abuse in Heroin Use Disorder Patients: An Unfolding Metabolic Destiny 
The presenters, on the basis of their clinical experience, suggest that poly drug abuse in heroin addicts could be correlated with condition of opiate dependence improperly compensated by street heroin or by agonist opioid treatment dosages. Thus the search for an appropriate methadone dosage is crucial not only because it enhances patients’ retention rate within the treatment group, allowing an improvement in social rehabilitation, but also because it reduces the risk of poly drug abuse.

Former Heroin Use Disorder Patients Now Alcohol Use Disorder Patients (FHA-AUD): Addiction History and Clinical Feature
The prevalence of FHA-AUD patients is not negligible. This may relate to previous inadequate treatment of heroin addiction contributing to the development of severe AUD. For these patients we propose a reconsideration of ‘soft’ (low dose) agonist opiate treatment.

Treatment of Alcohol Misuse during Methadone Treatment and Treatment of Alcohol Misuse in Former Heroin Use Disorder Patients
After reviewing the data in the literature on the use of Gamma Hydrossibutiric Acid (GHB) in alcoholics and other kinds of abusers, several cases of alcoholabusing heroin addicts will be described, in which adequate dosages of methadone and the use of GHB proved to possess some effectiveness, even if there were major limitations regarding compliance and completeness of response. In responding to the challenge of identifying different alcoholic sub-groups that can benefit from specific treatment, we want to shed light on the idea that alcoholics with a history of heroin use should be considered a specific group, and a treatment target should be set on the rebalancing of the opioidergic system after passing through agonist opioid treatment.


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