Compulsory supervision and methadone maintenance

Drug and Alcohol Dependence

et al. 2011

122

104

Background Longer tenure in methadone treatment has been associated with positive outcomes such as reductions in drug use and crime, HIV seroconversion, and overdose death. Methods Retention in treatment was examined for 351 opioid-dependent individuals who had been newly admitted to one of six methadone programs in Baltimore, Maryland. Cox proportional hazards regression was used to predict number of days retained in treatment to 90 days from baseline ASI Composite scores and Treatment Motivation scales. A second analysis predicted days in treatment to 365 days using the same baseline variables plus 3-month Motivation scales, Patient Satisfaction scales, and methadone dose in the 248 individuals who had remained in treatment at least 3 months. Analyses held constant gender, race, age, whether participants had a history of regularly smoking cocaine, whether participants were on parole/probation, and program site. Results Retention at 90 days was predicted by female gender, and greater baseline Treatment Readiness (p=.005) but lower Desire for Help (p=.010). Retention at 365 days was predicted by higher baseline ASI Medical Composite scores (p=.037) and lower Legal Composite scores (p=.039), higher 3-month Treatment Satisfaction scores (p=.008), and higher dose (p=.046). Conclusions Greater satisfaction with treatment at 3 months was a significant predictor of retention at 12 months, indicating the importance of understanding the role satisfaction plays in determining retention. Greater severity of legal problems was associated with shorter retention, suggesting that program efforts to increase services to criminal justice patients (e.g., legal counseling) may constitute a useful addition to treatment.

Section: Introductionmentioning

confidence: 99%

Predictors of methadone treatment retention from a multi-site study: A survival analysis

Kelly

O’Grady

Drug and Alcohol Dependence

et al. 2011

122

104

“…Yet despite Food and Drug Administration approval for methadone treatment for opioid addiction treatment, strong evidence from clinical trials and meta-analyses of the effectiveness of such treatment in reducing opioid use (Mattick, Breen, Kimber, & Davoli, 2009), and the recommendation of its use by the National Institutes of Health (NIH, 1998), the Institute of Medicine (Institute of Medicine, 2006), and the World Health Organization (WHO, 2005), methadone treatment has been underutilized in parole and probation settings (Gryczynski et al, 2012). This underutilization persists despite evidence that methadone treatment is effective for probationers and parolees (Anglin, 1988; Brecht & Anglin, 1993; Desmond & Maddox, 1996; Gryczynski et al, 2012; Kelly et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of African American Buprenorphine Patients by Parole and Probation Status

Gryczynski

Kelly

et al. 2013

Journal of Drug Issues

This secondary analysis compared outcomes of African-American adults newly-admitted to buprenorphine treatment who were on parole and probation to patients who were not under criminal justice supervision. Buprenorphine patients (N=300) were randomly assigned to receive either Intensive Outpatient Treatment (IOP) or Standard Outpatient Treatment (OP) treatment and were assessed at baseline, 3- and 6-months. There were no differences between groups in treatment retention. Among probationers/parolees, IOP was associated with lower 3-month treatment retention compared to OP, but among participants not on probation/parole the relationship was reversed (p=.004). Both conditions showed significant declines in heroin and cocaine use, illegal activity, and in meeting DSM-IV criteria for opioid and cocaine dependence. Probationers/parolees reported lower frequency of illegal activities at 3-months compared to non-probationers/parolees (p=.007). Buprenorphine treatment should be made more widely available to individuals on parole/probation as they respond as well to treatment as patients not supervised by the criminal justice system.

“…Previous research on patient characteristics associated with greater treatment retention include older age of onset of heroin addiction (Magura et al 1999; Ball & Ross 1991) and motivation or readiness for treatment (Joe et al 1998), but not criminal justice status (Fallon 2001; Desmond & Maddux 1996). Prior number of attempts at methadone treatment also appears to be associated with greater retention (Koester et al 1999; Rhoades et al 1998).…”

Section: Introductionmentioning

confidence: 99%

Premature Discharge from Methadone Treatment: Patient Perspectives

Reisinger

Schwartz

Journal of Psychoactive Drugs

et al. 2009

Longer retention in drug abuse treatment is associated with better patient outcomes and research indicates the first 12 months of methadone treatment are critical to patient success. Nevertheless, large-scale multi-site longitudinal studies over the past three decades indicate that the majority of patients drop out during the first year of methadone treatment. Through an examination of 42 qualitative interviews with patients prematurely discharged from six methadone treatment programs in Baltimore, this paper highlights factors patients describe as contributing to their reasons for being discharged within the first 12 months of the treatment. The two most consistent themes are programrelated factors and incarceration. The former factors are richly described through patients' words and underscore the ways in which patients' perceptions of control exerted by the program and by the medication and misunderstandings of program structure can lead to premature discharge. Patients' reasons for discharge were compared to counselors' reasons as indicated in discharge summary forms. An analysis of the patterns of agreement and disagreement are presented. Patient-centered program and policy implications are discussed.