BACKGROUND. Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs. METHODS. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group. RESULTS. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%). CONCLUSIONS. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment.

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.

Time in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patient retention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methadone treatment. This analysis compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12-month retention rates for patients admitted directly to a traditional methadone clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention (p = 0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three- and six-month retention rates of interim clinic patients fall within the range of six-month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups.

The relationship between public policy and scientific investigation is explored by a review of the experience with methadone maintenance treatment for narcotic addiction. The implementation of a widespread treatment effort in Hong Kong in the 1970s is contrasted with recent policies in regard to methadone treatment expansion in the United States. In neither case did research findings form the basis for public policy. In Hong Kong, rapid expansion of methadone treatment was initiated before scientific evidence was available to support this course, and in the United States treatment expansion has been rejected despite extensive evidence of its utility and safety. Decisions by government officials and health care providers, as in the case of addiction treatment, may be influenced more by philosophy and intuition than by scientific evidence. Scientists must recognize and address this reality if they are to play a meaningful role in shaping public health policy.

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