Retention of Patients Who Entered Methadone Maintenance Via an Interim Methadone Clinic

Abstract

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.

Dropout from Interim Methadone and Subsequent Comprehensive Methadone Maintenance

“…The majority of patients who initiated IM successfully transitioned to comprehensive methadone maintenance and remained in treatment six months thereafter. The observed dropout rates are in line with those seen in traditional methadone maintenance (e.g., 8,12). Patient subgroups that may be more vulnerable – such as intravenous users, patients with concomitant cocaine problems, or those with lengthier incarceration experiences – were not found to be disproportionately likely to discontinue IM or comprehensive treatment following IM.…”

“…However, in the study from which this analysis draws, too few individuals in the waiting list control sample actually entered comprehensive methadone treatment to permit an in-depth examination of that condition. Previous analyses have found that those who entered comprehensive treatment through IM generally had superior outcomes to the small number who entered via the standard waiting list (8). Future research should examine predictors of outcome in IM in more detail and examine reasons for dropout, which may include incarceration, patients leaving against medical advice, or administrative discharge by the program (25).…”

“…This retrospective study draws from the parent clinical trial of IM (7,8) in which heroin-addicted individuals seeking treatment at an urban OTP were randomly assigned to either IM or to remain on the standard waiting list on a 3:2 ratio. Individuals randomized to the IM condition received IM for up to 120 days prior to transfer to comprehensive treatment.…”

“…An early study found that retention was not different for patients who accessed comprehensive treatment via IM and those admitted to comprehensive treatment directly (9). A more recent analysis (8) found that IM did not reduce, and on some measures even improved, the efficacy of subsequent comprehensive treatment relative to comprehensive treatment accessed through the standard waiting list pathway. These findings are encouraging, and further research could help to optimize IM as a service delivery strategy.…”

“…A randomized trial of IM vs . standard waiting list found that individuals in the IM condition had superior outcomes in entry to comprehensive treatment, heroin use, money spent on drugs, and illegal income (7), with IM continuing to outperform standard waiting list control at 10 month follow-up (8). …”