The Effectiveness of Methadone Maintenance Treatment

Ball, John C.; Ross, Alan S. C.

doi:10.1007/978-1-4613-9089-3

Cited by 679 publications

(424 citation statements)

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“…Both population and clinical surveys (Ball and Ross, 1991;Caetano and Weisner, 1995;Helzer and Pryzbeck, 1988;Martin et al, 1996;Tsuang et al, 1994;Regier et al, 1990) indicate that the majority of those with a current substance use disorder use multiple psychoactive substances and meet current or lifetime criteria for a number of substance use disorders. For example, estimates indicate that 30-60% of alcoholdependent individuals abuse cocaine (Caetano and Weisner, 1995;Martin et al, 1996;Tsuang et al, 1994), 20-50% abuse marijuana (Caetano and Weisner, 1995;Martin et al, 1996;Tsuang et al, 1994), 12-20% abuse benzodiazepines (Ciraulo et al, 1988;Ross, 1993) and 7-10% abuse heroin (Caetano and Weisner, 1995;Martin et al, 1996;Tsuang et al, 1994).…”

Section: Unrepresentative Subject Groupmentioning

confidence: 99%

“…Prevalence of marijuana abuse in cocaine-dependent patients ranges from 25 to 70% (Higgins et al, 1994;Hubbard, 1990;Schmitz et al, 1991), and lifetime prevalence of alcohol dependence exceeds 65% in both treatment-seeking cocaine users as well as those not seeking treatment (Carroll et al, 1993). Fifty, 33, 47 and 69% of heroin-dependent patients are regular users of alcohol, benzodiazepines, cocaine, and marijuana, respectively (Ball and Ross, 1991). Cigarette smoking is also common, with up to 63-90% of treatmentseeking substance abusers reporting daily nicotine use (Budney et al, 1993;Burling and Ziff, 1988;Cunningham-Williams et al, 2000).…”

Section: Unrepresentative Subject Groupmentioning

confidence: 99%

“…Examining the effects of pharmacotherapies on multiple classes of drugs may also reveal unexpected beneficial effects, as medications may reduce use of drugs other than the targeted one via direct or indirect mechanisms. For example, methadone maintenance treatment is associated with not just reductions in opioid use, but decreases in other drug use, such as cocaine and benzodiazepines, as well (Ball and Ross, 1991). Naltrexone can be used for treating both opioid (Greenstein et al, 1997) and alcohol (O'Malley et al, 1992;Volpicelli et al, 1992) dependence.…”

Section: Limited Generalization Of Safety and Efficacy Findingsmentioning

confidence: 99%

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Single versus multiple drug focus in substance abuse clinical trials research

Rounsaville

Petry

Carroll

2003

Drug and Alcohol Dependence

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Complex patterns of multiple substance use pose clinical and methodological challenges for substance abuse clinical trials research. To increase measurement precision and internal validity, the modal approach has been to target both treatment interventions and outcome assessment to a single class of abused substance. This strategy warrants reconsideration because it entails limitations in recruitment feasibility and generalization of study findings. This report reviews pros and cons of single versus multiple targeted drugs, suggests guidelines for choosing between these strategies and outlines methods for broadening the scope of substance abuse clinical trails to take abuse of multiple substances into account. We recommend that investigators consider moving away from a single drug focus in three ways. First, include systematic assessment of a wide range of psychoactive substance use throughout the trial and evaluate the impact of study treatments on use of all classes of drugs. Second, except where contraindicated, include patients who use and abuse multiple classes of substances even in trials evaluating treatment of a single targeted drug. Third, consider inclusion of polysubstance abusers or those who primarily abuse multiple classes of substances in the same clinical trial. Although many treatment efficacy questions can best be answered by single focus studies, we recommend that such designs be adopted only after less restrictive designs are first considered.

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Section: Unrepresentative Subject Groupmentioning

confidence: 99%

Section: Unrepresentative Subject Groupmentioning

confidence: 99%

Section: Limited Generalization Of Safety and Efficacy Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Single versus multiple drug focus in substance abuse clinical trials research

Rounsaville

Petry

Carroll

2003

Drug and Alcohol Dependence

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“…Evidence accumulated over many years shows that stable methadone maintenance patients who withdraw from methadone have relapse rates approaching 80-85 % within 1 year [23]. In methadone-maintained patients, there are demonstrated reductions in death rates [24], reductions in the rates of intravenous drug use [23], reductions in crime [5,25,26], and reductions in rates of HIV seroconversion [27,28]. During 1983-84 the prevalence of HIV infection in untreated heroin addicts in New York City was 50-60 %, while only 9 % of methadone maintenance patients had the HIV-1 antibody [29].…”

Section: Methadone Maintenance Effectivenessmentioning

confidence: 99%

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

Salsitz

Wiegand

2015

J. Med. Toxicol.

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Methadone maintenance therapy (MMT), a pharmacological treatment for opioid use disorder for the past 50 years, continues to remain controversial. Despite consistent and overwhelming evidence confirming the effectiveness and safety of MMT, misconceptions and myths persist regarding its legitimacy as a treatment for opioid addiction. This often results in the underutilization and limited availability of this treatment modality. Despite successful outcomes, the controversial nature of MMT, and the stigma experienced by the patients on methadone, has been a particularly difficult obstacle to overcome. We present the history of MMT, review the evidence for its efficacy in the treatment of opioid dependence, and explore the origins of the stigma and misconceptions related to MMT.

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“…About 58% of patients entering methadone maintenance treatment abuse cocaine (Ball & Ross, 1991). Although numerous clinical trials have failed to identify an effective pharmacologic approach for cocaine dependence (O'Brien, 1997), three recent trials have suggested the effectiveness of disulfiram in a range of settings, including methadone maintenance (MM) programs (Carroll et al, 1993Carroll, Nich, Ball, McCance, & Rounsaville, 1998;George et al, 2000, Petrakis et al, 2000.…”

Section: Introductionmentioning

confidence: 99%

Cost effectiveness of disulfiram

Jofre‐Bonet

Sindelar

Petrakis

et al. 2004

Journal of Substance Abuse Treatment

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Converging evidence suggests that disulfiram is a promising treatment for cocaine dependence. We study the cost-effectiveness of providing disulfiram to methadone-maintained opioid addicts in a randomized clinical trial setting. Our economic evaluation is based on a double blind clinical trial in which 67 cocaine-dependent methadone-maintained opioid-dependent subjects were randomized to get the additional treatment of disulfiram or placebo in a 12-week trial.Outcome measures used are the number of days of cocaine use and grams of cocaine per week. Cost measures used are the cost of providing standard methadone treatment and the incremental cost of adding disulfiram to the standard treatment. Cost measures of standard and disulfiramenhanced treatment were collected retrospectively from the provider.Results from this cost-effectiveness analysis imply that, even though disulfiram increases slightly the cost of methadone treatment, its increase in effectiveness may be important enough to warrant its addition for treating cocaine dependence in methadone-maintained opiate addicts.

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The Effectiveness of Methadone Maintenance Treatment

Abstract: Library of Congress Cataloging-in-Publication Data Ball, John C. The effectiveness of methadone maintenance treatment: patients, programs, services, and outcome / John C. Ball, Alan Ross. p. cm. Includes bibliographical references. Includes index.

Cited by 679 publications

References 0 publications

Single versus multiple drug focus in substance abuse clinical trials research

Single versus multiple drug focus in substance abuse clinical trials research

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

Cost effectiveness of disulfiram

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