Retention in publicly funded methadone maintenance treatment in two western states

Deck, Dennis; Carlson, Matthew J.

doi:10.1007/bf02287327

Cited by 92 publications

(75 citation statements)

References 45 publications

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“…This may be due to the young age of the cohort overall. Gender has been associated with better retention in treatment with females more likely to be retained (17,39). This was consistent with our results, and though reasons in the Irish cohort are not clear, Kelly (17) found that males scored lower on the readiness for treatment scale.…”

Section: Discussionsupporting

confidence: 90%

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

Mullen

Barry

Long

et al. 2012

The American Journal of Drug and Alcohol Abuse

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Background: Retention in treatment is a key indicator of methadone treatment success. The study aims to identify factors that are associated with retention. Objectives: To determine retention in treatment at 12 months for Irish opiate users in methadone substitution treatment and to indicate factors that increase the likelihood of retention. Methods: National cohort study of randomly selected opiate users commencing methadone treatment in 1999, 2001, and 2003 (n ¼ 1269). Results: Sixty-one percent of patients attending methadone treatment remained in continuous treatment for more than 1 year. Retention in treatment at 12 months was associated with age, gender, facility type, and methadone dose. Age and gender were no longer significant when adjusted for other variables in the model. Those who attended a specialist site were twice as likely to leave methadone treatment within 12 months compared with those who attended a primary care physician. The most important predictor of retention in treatment was methadone dose. Those who received <60 mg of methadone were three times more likely to leave treatment. Conclusion: Retention in methadone treatment is high in Ireland in a variety of settings. The main factors influencing retention in methadone treatment was an adequate methadone dose and access to a range of treatment settings including from primary care physicians. Scientific Significance: Providing an adequate dose of methadone during treatment will increase the likelihood of treatment retention. Methadone treatment by the primary care physician is a successful method of retaining opioid users in treatment.

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Section: Discussionsupporting

confidence: 90%

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

Mullen

Barry

Long

et al. 2012

The American Journal of Drug and Alcohol Abuse

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“…Males tended to have longer breaks than females. Gender predicted retention in some previous studies [31] but not in others [13]. Findings generally favour females having a higher retention rate [22].…”

Section: Demographic Factorsmentioning

confidence: 58%

“…A retrospective cohort study of over forty thousand individuals prescribed opioid replacement therapy between 1985 and 2006 in Australia found that age had the biggest impact on risk of leaving treatment with older respondents having a lower prevalence of breaks in treatment [23]. This finding was replicated in similar large cohort studies in Switzerland, Shanghai, America and Ireland [21,22,25,31]. These studies focused primarily on breaks in treatment in last 12 months, while our research asked patients whether they ever had a break in treatment at any time.…”

Section: Demographic Factorsmentioning

confidence: 85%

“…Finally, a number of areas that would benefit from further research can be identified. While most studies measured retention in terms of length of time enrolled in treatment [13,31], this study focussed on breaks in treatment. One line of further investigation may be the association between breaks in treatment and patient outcomes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Demographic and clinical factors predicting retention in methadone maintenance: results from an Irish cohort

Darker

Kelly

et al. 2015

Ir J Med Sci

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Background Retention in Methadone Maintenance Treatment (MMT) is superior to that of other therapies for opioid addiction, but with international retention rates around 50 % after 1 year of treatment, there remains a need for improved retention rates. Aims This study aimed to explore the demographic and clinical factors predicting retention in MMT. Methods Face-to-face surveys with MMT patients in a Dublin methadone clinic were conducted. Retention was assessed by the presence and duration of breaks in treatment at any stage. Results 189 patients participated in the study. 46 % (n = 87) reported having at least one break in treatment, and the median duration of a break was 3 months. Age, current methadone dose and prescription of antipsychotic medication were significant predictors of retention. Patients who were older, single, living in their own home, on a higher dose of methadone, or taking antipsychotic medications had fewer breaks in treatment. Males tended to have significantly longer breaks. Patients reported that the main reasons for breaks were relapse into drug use (21.8 %, n = 19), incarceration (11.4 %, n = 10), weary of MMT (13.7 %, n = 12) or problems at the clinic (10.3 %, n = 9). Factors enabling regular attendance included wanting to get or stay clean (37.5 %, n = 51), avoidance of withdrawal symptoms (16.1 %, n = 22), methadone dependence (13.9 %, n = 19) and services provided (10.2 %, n = 14). Conclusion Patients who were older, single, living in their own home, on a higher dose of methadone, or taking antipsychotic medications had fewer breaks in treatment.

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“…These results are consistent with recent work on Oregon's methadone program for Medicaid clients. 48 Studies on Utah Medicaid clients with schizophrenia showed a powerful connection between continuity of Medicaid eligibility and use of inpatient psychiatric services. 49 Interestingly, in some cases in the present study, there was an interaction between months of Medicaid eligibility and before versus after managed care.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for medicaid clients with substance abuse problems before and after managed care

McFarland

Deck

McCamant

et al. 2005

The Journal of Behavioral Health Services & Research

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Medicaid conversion from fee for service to managed care raised numerous questions about outcomes for substance abuse treatment clients. For example, managed care criticisms include concerns that clients will be undertreated (with too short and/or insufficiently intense services). Also of interest are potential variations in outcome for clients served by organizations with assorted financial arrangements such as for-profit status versus not-for-profit status. In addition, little information is available about the impact of state Medicaid managed care policies (including client eligibility) on treatment outcomes. Subjects of this project were Medicaid clients aged 18-64 years enrolled in the Oregon Health Plan during 1994 (before substance abuse treatment managed care, N = 1751) or 1996-1997 (after managed care, N = 14,813), who were admitted to outpatient non-methadone chemical dependency treatment services. Outcome measures were retention in treatment for 90 days or more, completion of a treatment program, abstinence at discharge, and readmission to treatment. With the exception of readmission, there were no notable differences in outcomes between the fee for service era clients versus those in capitated chemical dependency treatment. There were at most minor differences among various managed care systems (such as for-profit vs not-for-profit). However, duration of Medicaid eligibility was a powerful predictor of positive outcomes. Medicaid managed care does not appear to have had an adverse impact on outcomes for clients with substance abuse problems. On the other hand, state policies influencing Medicaid enrollment may have substantial impact on chemical dependency treatment outcomes.

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Retention in publicly funded methadone maintenance treatment in two western states

Cited by 92 publications

References 45 publications

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

Demographic and clinical factors predicting retention in methadone maintenance: results from an Irish cohort

Outcomes for medicaid clients with substance abuse problems before and after managed care

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