Patterns of Abstinence or Continued Drug Use Among Methadone Maintenance Patients and Their Relation to Treatment Retention

Abstract

The efficacy and effectiveness of methadone maintenance treatment (MMT) in the medical management of opioid addiction has been well-established, but treatment outcomes are compromised by the continued use of licit and illicit drugs during MMT. The present study examined the relationship between in-treatment illicit drug use and retention and dropout of 604 MMT patients in Washington, D.C. Sixty-eight percent of patients did not test positive for an unprescribed drug during the study period. Of patients who tested positive for an illicit drug during the baseline period, 55% tested positive for cocaine, 44% for opiates, 23% for THC, 20% for benzodiazepines, 7% for PCP, and 4% for amphetamines. Those testing positive were three times more likely to leave treatment than those who did not test positive. Testing positive for one drug doubled the rate of attrition; testing positive for multiple drugs quadrupled the risk of attrition. Non-prescribed opioid or benzodiazepine use was a predictor of MMT dropout, but prescribed opioid or benzodiazepine use was not. Continued illicit drug use poses significant risk for subsequent premature termination of MMT. Assertive clinical management of continued illicit drug use could provide mechanisms to enhance MMT retention and long-term recovery outcomes.

Satisfaction With Methadone Among Heroin-Dependent Patients With Current Substance Use Disorders During Methadone Maintenance Treatment

“…In this study, we examined satisfaction with methadone in a subgroup of heroin-dependent patients of great interest to both clinicians and researchers: patients who compulsively use heroin and/or nonopioid substances during MMT. 1,[3][4][5][6][7] We were also able to identify 5 factors that were independently associated with SASMAT-METHER assessments in patients with current SUD: desire for a downward adjustment of methadone dose, patient perceived influence on methadone dose changes, days of heroin or cocaine use during last month, and years of education. Unexpectedly, we found that the desire to adjust the methadone dose downward was significantly associated with all dimensions of satisfaction with methadone.…”

“…1,[3][4][5] Interruption of the compulsive use of nonopioid substances is also often a secondary therapeutic goal of MMT. 1,[3][4][5] The use of certain nonopioid substances, including benzodiazepines 6 and cocaine, 3,7 has been found to be associated with heroin use during MMT. This finding suggests that methadone-induced changes in heroin addiction through selective substitution and blockage of the effects of heroin 8,9 could also lead to changes in the use of nonopioid substances.…”

Variations in Cannabis Use Level and Correlates in Opiate-Users on Methadone Maintenance Treatment: A French Prospective Study

“…This polysubstance use could reflect an association between behavioral disinhibition and a continuum of addiction defined primarily in terms of polysubstance involvement (Conway, Kane, Ball, Poling, & Rounsaville, 2003). In this context, it is not surprising to observe high rates for use of substances other than opiates among MMT patients, and addictive behaviors persisting after treatment initiation (Clarke et al, 2001;Moitra et al, 2013;Richter et al, 2001;SAMHSA, 2012;White et al, 2014). While not appearing to be significant factors of MMT discontinuation, these behaviors may suggest that many patients spend a considerable proportion of recovery time taking other substances and are likely to be exposed to many of the health risks inherent in chronic substance use (Kidorf et al, 2007).…”

“…Patients who initiate MMT are likely to concurrently use psychoactive substances other than opiates (Clarke, Stein, McGarry, & Gogineni, 2001;Moitra, Anderson, & Stein, 2013;Richter, Gibson, Ahluwalia, & Schmelzle, 2001;White et al, 2014), in particular cannabis, which is also the most-used illicit substance in industrialized countries (Compton, Thomas, Conway, & Colliver, 2005;Kidorf, Neufeld, King, Clark, & Brooner, 2007). Research results are mixed regarding the effect of MMT on cannabis use, and measurements of the drug's use during treatment are infrequently and irregularly reported in the literature (Amato et al, 2005;SAMHSA, 2012).…”

Association Between Family Factors and Illicit Polysubstance Use Amongst Methadone Maintenance Patients with Opioid Use Disorder

“…For example, it is possible that the presence of medical or psychiatric comorbidities plays a role in a patient's illicit polysubstance use (24). However, an attempt to control for some comorbidities was indirectly made, as all participants currently prescribed opioids were excluded from the final analysis.…”