A randomized trial of an interim methadone maintenance clinic.

Abstract

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.

Barriers to Opioid Substitution Treatment Access, Entry and Retention: A Survey of Opioid Users, Patients in Treatment, and Treating and Non-Treating Physicians

“…Notably, users in the East/ South were more likely to cite problems related to OST accessibility as reasons for staying out of treatment than users in the North/West. While it has been concluded that opioid substitution in itself can serve as a means of attracting opioid-dependent persons into treatment [14,15] , other treatment factors will affect recruitment and retention. An examination of the various treatment entry criteria that have been in place at different times and in different countries shows that the implementation of more restrictive criteria (e.g.…”

Social Contextual Factors Associated with Entry into Opiate Agonist Treatment Among Injection Drug Users

“…Drug abuse treatment, in particular methadone maintenance, has been associated with decreased drug use and reductions in other HIV-related risk behaviors such injection frequency, needle sharing (5)(6)(7)(8), and in some cases reduced sexual risk behaviors (9,10). Methadone maintenance treatment (MMT) has been associated with decreases in HIV incidence (5,11,12) and has been found to reduce the spread of hepatitis B and C, tuberculosis, and sexually transmitted infections (13).…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…(Finch et al, 1995;Langendam et al, 2001;Millson et al, 2007;Ryrie et al, 1997;Torrens et al, 1996;van Ameijden et al, 1999;Yancovitz et al, 1991). These findings are important given the growing number of people with opiate dependence across the world (Hernandez & Nelson, 2010;Manchikanti & Singh, 2008;Shield, Ialomiteanu, Fischer, Mann, & Rehm, 2011) and the calls to increase access to MMT.…”

“…Empirical comparisons to higher threshold MMT programs (i.e., programs with strict policies governing continued use of any illicit drug during treatment) show that low threshold MMT attract different types of clients (Ryrie, Dickson, Robbins, Maclean, & Climpson, 1997); have higher retention rates (Torrens, Castillo, & Pérez-Solá, 1996) and are associated with reductions in heroin use (Yancovitz et al, 1991), injection related HIV risk behaviors (Finch, Groves, Feinman, & Farmer, 1995;Millson et al, 2007), injectionrelated mortality (van Ameijden, Langendam, & Coutinho, 1999) criminal charges (Ryrie et al, 1997) and mortality (Langendam, van Brussel, Coutinho, & van Ameijden, 2001).…”