Effectiveness of Streamlined Admissions to Methadone Treatment: A Simplified Time-Series Analysis

Abstract

Increasing the availability of, and streamlining the admissions process to, methadone treatment have consistently been the focus of national plans to address the acquired immune deficiency syndrome (AIDS) epidemic. This article uses simplified time-series analysis to evaluate one of the first methadone treatment Waiting List Reduction Demonstration Grants. The demonstration grant significantly increased both the number of people requesting intake appointments from 35 to 100 per month and the percentage of kept appointments from 33% to 54%. An additional 100 slots (an entire year's waiting list) were filled in fewer than three months and actually resulted in a net increase in the length of the waiting list. Relative to the preceding two years, new clients during the grant period were significantly more likely to be 41 or older, African-American, unemployed, daily opioid users, daily cocaine users, and dependent on public assistance to finance treatment. Controlling for the source of treatment financing (a case-mix adjustment), there were no significant changes in retention rates. The program's static client capacity rose from 310 prior to the grant to a peak of 449 during the grant, with a leveling to 410 after the grant. Given that it is clearly more humane and less expensive to treat people who want treatment rather than wait for them to commit a crime and be arrested or even executed, this study strongly suggests the need to make more treatment available on demand.

Alternate-day buprenorphine dosing is preferred to daily dosing by opioid-dependent humans

“…Requiring daily attendance may not be a satisfactory response to this diversion, because daily attendance increases costs and decreases the number of potential treatment slots relative to procedures that permit a lower frequency of clinic attendance. Moreover, federal, state and local funding reductions for United States methadone programs continue despite increasing demand for services as evidenced by long waiting lists at many publicly funded treatment centers (Newman and Peyser, 1991;Dennis et al 1994;Wenger et al 1994). Therefore, clinically viable alternatives to methadone that eliminate the need for daily dispensing without increasing the risk of medication diversion should enhance e¤orts to meet the demand for treatment in a safe, productive and cost-e¤ective manner.…”

The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: A randomized controlled trial

“…These include the removal of intake delays (Dennis, Ingram, Burks, and Rachal, 1994; Schwartz et al, 2006), providing coupons for free treatment (Booth, Corsi, and Mikulick, 2003; Bux, Iguchi, Lidz, Baxter, and Platt, 1993; Sorensen, Constantini, Wall, and Gibson, 1993), case management (Mejta, Bokos, Mickenberg, Maslar, and Senay, 1997; Robles et al, 2004; Strathdee et al, 2006), addressing the lack of available treatment slots (Peterson et al, 2010; Schwartz et al, 2006), combining motivational interviewing with incentives (Kidorf et al, 2009; Kidorf, King, Gandotra, Kolodner, & Brooner, 2012), and eliminating treatment fees (Booth, Kwiatkoswki, Iguchi, Pinto, and John, 1998). Although these methods have increased treatment enrollment, about half or more of injection drug users exposed to these interventions remain outside of treatment.…”

Effectiveness of Rapid Intake into Methadone Treatment: A Natural Experiment in Israel

“…While some studies have found that rapid intake procedures predict longer periods of retention (e.g. [4,20]), others have found no correlation between length of the intake procedure and period of time retained in treatment (e.g. [5,21]).…”

“…Research has shown that longer waiting times are associated with lower rates of entry into treatment [4,5,16,17] and higher [13,18] or no change in retention rates [4]. A recent study in Israel found that longer waiting lists were a predictor of higher 1-year retention rates, yet suggested that this may be due to significant differences in sociodemographic characteristics between the groups.…”

“…Within these studies, emphasis is given to the task of encouraging addicts to enter treatment [3,4,5,6] and retaining them over time [7,8]. It has been suggested that for treatment to be successful, clients must be retained for at least 90 days [7] since clients who receive less than this minimal period of treatment do not differ from those who do not receive treatment at all [9,10,11].…”