Herbal Medicines Journal

Herbal Medicines Journal

An Investigation of the Effects of Methadone and Buprenorphine on Liver Enzymes (AST, ALT, ALP) and Blood Sugar in Drug-Dependent Patients: A Clinical Examination

Document Type : Original Article

Authors
Vajihe Khodadadzade Benhangi 1
Majid Rajabian 2
1 Department of Biological Sciences, Payame Noor University, Mashhad, Iran
2 Department of Biochemistry, Faculty of Biological Sciences, Payam Noor University of Iran, Tehran, Iran.
10.22087/hmj.2025.231630
Abstract
Background and Aim: The present study aimed to investigate the effects of the long-term use of opioids drugs, particularly buprenorphine and methadone, on drug addicts. The primary focus was to examine the possibility of tissue and pathological lesions in the liver, as well as their impacts on liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and fast blood sugar levels (FBS) in these individuals.
Materials and Methods: For this clinical study, 264 drug-dependent patients were selected from Imam Reza Hospital and two addiction treatment centers. The patients were divided into two groups. They received treatment with varying doses of methadone and buprenorphine. The study consisted of two phases. The first phase investigated the relationship between liver enzymes and blood sugar levels, with the methadone dose before and after treatment, while the second phase explored hypotheses related to the effectiveness of methadone compared with buprenorphine.
Results: The results of this study revealed a significant correlation between the levels of liver enzymes, blood sugar, and methadone consumption. Higher doses of methadone were found to be more effective in detoxification and withdrawal compared with buprenorphine. In other words, the prolonged and high-dose use of methadone led to tissue and hormonal damage.
Conclusion: Using of high doses of methadone and its long-term usage have more detrimental effects on the health and tissues of drug addicts' bodies.
Keywords
Methadone
Buprenorphine
Liver
Liver enzymes
Blood sugar levels
Drugs

  1.  

    1. ÇAKICI, M., et al., Comparison of methadone and buprenorphine.
    2. Qadirezadeh, et al. "The incidence of mortality due to drug abuse and stimulant misuse in bodies referred to the Forensic Medicine General Department of Kohgiluyeh and Boyer-Ahmad province during the years 1392 to 1397 (2013-2018)." Iranian Journal of Forensic Medicine, 2019, 25(2), 145-150. (persian)
    3. McKENNA, D.J., X.-M. Guan, and A. Shulgin, 3, 4-Methylenedioxyamphetamine (MDA) analogues exhibit differential effects on synaptosomal release of 3H-dopamine and 3H-5-hydroxytryptamine. Pharmacology Biochemistry and Behavior, 1991. 38(3): p. 505-512.
    4. Dhawan, A., T. Modak, and S. Sarkar, Transdermal buprenorphine patch: potential for role in management of opioid dependence. Asian Journal of Psychiatry, 2019. 40: p. 88-91.
    5. Surwit, R.S., et al., Differential glycemic effects of morphine in diabetic and normal mice. Metabolism, 1989. 38(3): p. 282-285.
    6. Ajayi, O.B. and A. Odutuga, Effect of low‐zinc status and essential fatty acids deficiency on the activities of aspartate aminotransferase and alanine aminotransferase in liver and serum of albino rats. Food/Nahrung, 2004. 48(2): p. 88-90.
    7. Karimi et al. conducted a study on the addiction to morphine and heroin and their impacts on the heart and cardiovascular diseases. The findings were published in the Journal of Findings in 2021, volume 23, issue 2, pages 21-34.(persian)
    8. Zaugg, M., et al., Anaesthetics and cardiac preconditioning. Part II. Clinical implications. British journal of anaesthesia, 2003. 91(4): p. 566-576.
    9. Arefnasab, Z., et al., The effect of methadone maintenance treatment (MMT) on the mental health of opium and heroin addicts. 2007.
    10. Johnson, B.A., Addiction medicine. Science and Practice, 2011.
    11. Barnett, P.G., Comparison of costs and utilization among buprenorphine and methadone patients. Addiction, 2009. 104(6): p. 982-992.
    12. Bush, E., C. Miller, and I. Friedman, A case of serotonin syndrome and mutism associated with methadone. Journal of Palliative Medicine, 2006. 9(6): p. 1257-1259.
    13. Dole, V.P. and M. Nyswander, A medical treatment for diacetylmorphine (heroin) addiction: a clinical trial with methadone hydrochloride. Jama, 1965. 193(8): p. 646-650.
    14. Langrod, J., J. Lowinson, and P. Ruiz, Methadone treatment and physical complaints: a clinical analysis. International Journal of the Addictions, 1981. 16(5): p. 947-952.
    15. Reddy, S., et al., The effect of oral methadone on the QTc interval in advanced cancer patients: a prospective pilot study. Journal of palliative medicine, 2010. 13(1): p. 33-38.
    16. Walter, A., Possible hepatotoxic effect of methadone. Canadian Medical Association Journal, 1969. 100(5): p. 265.
    17. Lapierre, J., Possible hepatotoxic effect of methadone. Canadian Medical Association Journal, 1969. 101(2): p. 113.
    18. James, R.C., R.W. Freeman, and R.D. Harbison, l-α-Acetylmethadol-induced tissue alterations in mice. Drug and Chemical Toxicology, 1984. 7(1): p. 91-112.
    19. Palat, G. and S. Chary, Practical guide for using methadone in pain and palliative care practice. Indian journal of palliative care, 2018. 24(Suppl 1): p. S21.
    20. Haddadi et al. (2019) compared the effects of methadone and buprenorphine on the hormonal profile (sexual) and seminal fluid analysis (fertility) in men undergoing maintenance treatment. The study was published in the Clinical Excellence Journal, 2019, 9(1), 48-60.(persian)
    21. Elkader, A. and B. Sproule, Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence. Clinical pharmacokinetics, 2005. 44: p. 661-680.
    22. McNicholas, L., George E. Woody University of Pennsylvania School of Medicine Laura McNicholas Philadelphia Veterans Affairs Medical Center. New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions, 2004: p. 125.
    23. West, S.L., K.K. O'Neal, and C.W. Graham, A meta-analysis comparing the effectiveness of buprenorphine and methadone. Journal of substance abuse, 2000. 12(4): p. 405-414.
    24. White, L.D., et al., Efficacy and adverse effects of buprenorphine in acute pain management: systematic review and meta-analysis of randomised controlled trials. British journal of anaesthesia, 2018. 120(4): p. 668-678.
    25. Böger, R.H., Renal impairment: a challenge for opioid treatment? The role of buprenorphine. Palliative medicine, 2006. 20(8_suppl): p. 17-23.
    26. Hamid, Z. et al. conducted a study to investigate the effects of systemic morphine administration on insulin, leptin, and serum TNF-alpha levels in diet-induced obese rats. The study aimed to examine the impact of morphine on metabolic parameters in the context of high-energy diet.(persian)
    27. Asgary, S., et al., Effect of opium addiction on new and traditional cardiovascular risk factors: do duration of addiction and route of administration matter? Lipids in health and disease, 2008. 7(1): p. 1-5.
    28. Shirani, S., et al., Can opium abuse be a risk factor for carotid stenosis in patients who are candidates for coronary artery bypass grafting? Cardiology journal, 2010. 17(3): p. 254-258.