A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification

Abstract

Background-Important questions remain regarding the necessary duration and intensity for methadone treatment to be effective. (Batki et al., 2002), patients with opioid dependence were recruited from an outpatient 21-day methadone detoxification program and were randomly assigned to one of three treatment conditions: 1) continuation in 21-day methadone detoxification; 2) transfer to six-month methadone maintenance with only minimal counseling; or 3) transfer to six-month methadone maintenance with standard twice monthly counseling and as-needed social work and psychiatric services. Both of the six-month maintenance treatments were followed by 1.5 months of detoxification. Urine drug tests and self-report measures were collected at baseline, months 1 through 6, and month 8.5. Methods-As part of a clinical trial of tuberculosis chemoprophylaxisResults-Compared to 21-day methadone detoxification, six-month methadone maintenance with either minimal or standard counseling resulted in fewer opiate positive urine tests and days of selfreported heroin and alcohol use. There was no change in cocaine use or other outcome measures. The increased counseling available in the standard counseling condition did not appear to reduce heroin use further than the minimal counseling condition, in contrast to the effect found for more structured counseling in long-term methadone maintenance (McLellan et al., 1993).Conclusions-Six months of methadone maintenance, even with minimal counseling, reduces heroin and alcohol use more than 21-day methadone detoxification.

Factors associated with methadone treatment among injection drug users in Bangkok, Thailand

“…This indicates that methadone treatment in Thailand may not confer conventional benefits in terms of reduced drug use and longer periods of abstinence. This is not entirely surprising given that most methadone treatment programs in Thailand offer longer-term tapered "detoxification" regimens and tend to dose low, usually less than 50 mg/day, which is known to be associated with decreased retention in treatment and lower rates of drug cessation (Faggiano, Vigna-Taglianti, Versino, & Lemma, 2003;Gruber, Delucchi, Kielstein, & Batki, 2008). Although Thailand's National Health Security Program has recently passed a resolution to cover the cost of methadone treatment (National AIDS Prevention and Alleviation Committee, 2010), efforts are now needed to ensure accessibility for opioid-dependent IDU and that international treatment guidelines pertaining to methadone treatment are adhered to with respect to dosing and duration (Ainsworth, Beyrer, & Soucat, 2003;Sharma et al, 2009).…”

Interim treatment: Bridging delays to opioid treatment access

“…While Yancovitz and colleagues (1991) noted that ongoing cocaine use predicted poorer response to interim treatment, which is consistent with prior studies in more traditional methadone maintenance settings (e.g., Preston et al, 1998), other efforts have failed to identify predictors of interim treatment response (Highfield et al, 2007). The ability to distinguish those who will likely need more intensive psychosocial services in order to succeed (e.g., McLellan et al, 1993) from those who may fare well receiving medication alone (e.g., Gruber et al, 2008; Schwartz et al, 2011) is important, especially under conditions of limited resources.…”

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

“…Evaluation of cocaine use among MMT patients does not show promising results, although results are better if accompanied by psychosocial therapy. [68][69][70][71][72] For example, a study with almost 400 MMT patients showed that at 18 months there was no change in cocaine use; however, cocaine powder and speedball use decreased, and smoking crack significantly increased. 73 Another recent study using contingency management showed that at 6 months follow-up visits participants that continued on methadone treatment, compared to those not in treatment, did not differ in their cocaine-dependence diagnosis.…”