Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.

Abstract

OBJECTIVES: This study examined two major methadone treatment factors, visit frequency and methadone dose, posited to be important in reducing intravenous drug use and human immunodeficiency virus (HIV) transmission. METHODS: One hundred fifty opiate-dependent subjects randomly assigned to four groups received 50 or 80 mg of methadone and attended a clinic 2 or 5 days per week. RESULTS: Survival analysis indicated higher dropout rates for groups having five vs two visits per week (Chi2[1]=7.76). Higher proportions of opiate-positive results on urine screens were associated with lower methadone doses (F[1,91]=4.74). CONCLUSIONS: Receiving take-home doses early in treatment enhanced treatment retention. The 50-mg dose combined with five visits per week produced the worst outcome. Fewer visits enhanced retention at 50 mg, but opiate use rates were higher at this dose than they were for either 80-mg group. The HIV infection rate at entry was 9%. No subjects seroconverted during the study. Risk behaviors for acquired immunodeficiency syndrome declined over time regardless of group/dose assignment. These results have important implications for modification of regulatory and clinic policy changes.

Beliefs About Methadone in an Inner-City Methadone Clinic

“…This dissonance is well summarized by a 34-year-old patient, who reported 6 years of methadone treatment uncertainty about its effects on his health: "It saved my life even though I find it to be liquid handcuffs." The difficulty of frequent visits to a methadone clinic expressed here has been noted in other research 17 and in government publications. 18 In addition, the concerns about the safety of methadone and the goal of getting off methadone are consistent with clinical observations.…”

Agonist-Like or Antagonist-Like Treatment for Cocaine Dependence with Methadone for Heroin Dependence: Two Double-Blind Randomized Clinical Trials

“…Methadone at 1.1 mg/kg is roughly comparable, though slightly lower than the upper dose used in our earlier research (Rhoades et al, 1998) and by others (Strain et al, 1999) in single diagnosis subjects. Retention was about the same or better than that reported for a large methadone treatment clinic for the 'high dose' (4100 mg) in long-term well-stabilized patients (Maxwell and Shinderman, 2002).…”

“…A divergent response for retention vs cocaine use reductions at different doses paralleled other agonist literature; for example, the utility of methadone varies as a function of dose (Rhoades et al, 1998;Strain et al, 1999), clinical circumstances of its administration (Ball and Corty, 1988), and other environmental factors (Rhoades et al, 1998). Variability should also be expected in the stimulant substitution case.…”

“…Both forms of pharmacotherapy have been effectively used for heroin dependence. Methadone can effectively reduce heroin use even in the presence of persistent or increased cocaine use (Rhoades et al, 1998). Effects of methadone on concurrent cocaine use are equivocal with reports of both reductions and increases in use in methadone-maintained patients (Stine et al, 1991;Rhoades et al, 1998).…”

Prevention and Treatment of HIV Infection in Injection Drug Users in the Bronx

“…Substance abuse treatment is an effective method of prevention of HIV infection in IDUs (Cooperman et al, 2005;Marsch, 1998;Monterroso et al, 2000;Rhoades et al, 1998;Sorenson and Copeland, 2000;Woods et al, 1999). On an individual level, substance abuse treatment programs curb risk behaviors by helping patients reduce or stop drug use, thereby reducing needle use, which helps prevent the spread of HIV.…”