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A Pilot Crossover Trial of Sleep Medications for Sleep-disturbed Methadone Maintenance Patients
Michael D Stein1, Megan E Kurth, Bradley J Anderson
1Butler Hospital, Providence, RI (MDS, MEK, BJA, CEB); Warren Alpert Medical School of Brown University, Providence, RI (MDS, CEB); and Boston University School of Public Health, Boston, MA (MDS).
Objectives:
Problems with sleep are a common and detrimental occurrence among individuals who receive methadone maintenance for opioid use disorder (OUD).
Methods:
We enrolled ten methadone-maintained persons with insomnia (60% female, mean age 40) in a double-blind trial using actigraphy to confirm daily sleep reports. After a no-medication week to establish baseline sleep patterns, each participant received 1 week each of mirtazapine (30 mg), zolpidem (sustained-release 12.5 mg), mirtazapine (30 mg IR) plus zolpidem (10 mg), and placebo, with a washout week between each medication week. Study medication order was randomized so that the order of each 1-week medication treatment was different for each participant, but all participants received all 4 regimens.
Results:
We found that mirtazapine alone improved total sleep (mean 23 minutes), sleep latency (mean 23 minutes), and sleep efficiency (mean 3%), surpassing the other regiments.
Conclusions:
This pilot work suggests that mirtazapine is worthy of further testing as a sleep aid for persons with OUD receiving methadone maintenance.
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