Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12‐month findings

Abstract

Aims This study aimed to determine the relative effectiveness of 12-months of Interim Methadone (IM; supervised methadone with emergency counseling only for the first 4 months of treatment), Standard Methadone treatment (SM; with routine counseling) and Restored Methadone treatment (RM: routine counseling with smaller caseloads). Design A randomized controlled trial was conducted comparing: IM, SM, and RM treatment. IM lasted for 4 months after which participants were transferred to SM. Setting The study was conducted in two methadone treatment programs in Baltimore, MD, USA. Participants The study included 230 adult methadone patients newly-admitted through waiting lists. Measurements We administered the Addiction Severity Index and a supplemental questionnaire at baseline, 4-, and 12-months post- baseline. Measurements included retention in treatment, self-reported days of heroin and cocaine use, criminal behavior and arrests, and urine tests for heroin and cocaine metabolites. Findings At 12 months, on an intent-to-treat basis, there were no significant differences in retention in treatment among the IM, SM and RM groups (60.6%, 54.8% and 37.8%, respectively). Positive urine tests for the three groups declined significantly from baseline (ps<0.001 and 0.003, for heroin and cocaine metabolistes respectively) but there were no significant Group x Time interactions for these measures. Thirty-one percent of the sample reported at least one arrest during the year, but there were no significant between-group effects. Conclusions Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin - at least for the first 4 months of treatment.

Interim treatment: Bridging delays to opioid treatment access

“…These reductions in risk behavior were generally comparable across groups, with one exception: the interim treatment group showed greater reductions in criminal activity than the standard methadone group at the 2-month timepoint (p<.05). Finally, the authors conducted a subsequent 12-month follow-up assessment, which translated to 8 months after the interim group had been transitioned to standard methadone treatment (Schwartz et al, 2012). At this second evaluation, there were no differences between the interim, standard and restored methadone groups in treatment retention (60.6%, 54.8% and 37.8%, respectively; p=.09) or percent of heroin-positive urine specimens (46%, 48% and 51%, respectively; p=.91).…”

Congress 60: An Addiction Recovery Community within the Islamic Republic of Iran

“…This raises the question of whether combining or sequencing potent ingredients of ABT and MAT may produce outcomes superior to either used in isolation. Studies that have attempted Downloaded by [New York University] at 03:09 21 July 2015 such combinations, including combining methadone maintenance with varied levels of counseling or psychotherapy (Gruber, Delucchi, Kielestein, & Batiki, 2008;McLellan, Woody, Luborsky, & Goehl, 1988;Schwartz, Kelly, O'Grady, Gandhi, & Jaffe, 2011), ancillary social services (McLellan et al, 1998), recovery mutual aid participation (White et al, 2014), or concurrent treatment in a therapeutic community (De Leon et al, 1995;Sorensen et al, 2009), have produced promising but mixed results. Such studies need to be continued using different combinations of pharmacotherapy and psychosocial recovery support in different cultural contexts.…”

Manualized Psychosocial Treatment Versus Standard Care in Opioid Maintenance Treatment: Results of a Randomized Clinical Trial and Follow-up Study

“…Schwartz et al [31] found no differences in 12-month outcomes of patients on standard methadone treatment with routine counseling and those who received no counseling. In addition, Mitchell et al [24] did not find differences in buprenorphine-maintained patients on intensive or standard outpatient treatment.…”

“…Opioid maintenance can be viewed as a platform for interactions to support recovery [31], but the optimal psychosocial intervention is a matter of debate, and the use of psychosocial interventions varies significantly across Europe (www.emcdda). Best practice WHO guidelines recommend that psychosocial support is routinely offered alongside pharmacological treatments.…”