Medical Maintenance:

Abstract

In a one year study, 130 methadone maintained subjects with a six month history of good treatment performance were assigned randomly to an experimental condition of one monthly non-random urine screen, one monthly counseling session, one monthly doctor visit, two times per month methadone pick up, a quarterly true random urine screen and participation in a diversion control program or to a control condition of staying under standard conditions for six months and then being transferred to the experimental condition for six months. Results of urine screens and scores on the Addiction Severity Index (ASI) at entrance and six month intervals showed no differences between groups. Three out of four subjects completed the year in good standing. Subject satisfaction was such that the IRB judged that return to standard conditions would be a hardship. Experimental conditions were cheaper such that resources freed up could be applied to the HIV epidemic.

A 12-month controlled trial of methadone medical maintenance integrated into an adaptive treatment model

“…Despite positive reports evaluating the use of MMM interventions in patients with long-term stable and positive treatment responses (Fiellin et al, 2001;Novick et al, 1994; Salsitz et al, 2000;Schwartz, Brooner, Montoya, Currans, & Hayes., 1999;Senay et al, 1993), adoption of the intervention has been slow. At least two unresolved issues may be hindering the broader adoption of this intervention in community-based treatment settings: The first issue involves the lack of research on effective management strategies for MMM patients who relapse to drug use.…”

“…At least two unresolved issues may be hindering the broader adoption of this intervention in community-based treatment settings: The first issue involves the lack of research on effective management strategies for MMM patients who relapse to drug use. Patients in previous studies who relapsed and could not be adequately treated in an office-based setting were returned to methadone maintenance clinics and not allowed to return to the MMM schedule (Fiellin et al, 2001;Salsitz et al, 2000;Schwartz et al, 1999;Senay et al, 1993). This amounts to a permanent intensification of treatment services that is likely unnecessary in many instances and perhaps to a more punitive versus therapeutic response to otherwise expected lapses to drug use.…”

Innovations in Treatment for Drug Abuse: Solutions to a Public Health Problem

“…Two published studies have reported successful medical maintenance programs in which stabilized (e.g. no evidence of active drug use for 1 or more years) methadone-maintained patients were transferred from care in narcotic treatment programs to medical maintenance settings (76,77,96). These programs have reported retention rates of 73%-85% for up to 3 years in some patients (77,96).…”

“…no evidence of active drug use for 1 or more years) methadone-maintained patients were transferred from care in narcotic treatment programs to medical maintenance settings (76,77,96). These programs have reported retention rates of 73%-85% for up to 3 years in some patients (77,96). These favorable statistics suggest that medical maintenance programs may be used to expand access to methadone maintenance and reduce overcrowding in narcotic treatment programs.…”

A 5-year evaluation of a methadone medical maintenance program

“…In the UK and Australia, this spectrum of opioid agonist treatment intensity across different settings is well established (Byrne & Wodak 1996;Luger, Bathia, Alcorn, & Power, 2000;Strang et al, 2005). Initial reports from such office-based initiatives in the United States (known as methadone medical maintenance [MMM]) demonstrated their feasibility and effectiveness (DesJarlais, Joseph, Dole, & Nyswander, 1985;Novick et al, 1994;Novick et al, 1988;Senay et al, 1993). Two randomized controlled trials demonstrating comparable outcomes at 6 months between the MMM approach and standard methadone maintenance have been published (Fiellin et al, 2001;King et al, 2002).…”