Treatment Fees and Retention on Methadone Maintenance

Abstract

Several reports have suggested that required treatment fees impair retention on methadone maintenance. In a controlled study, 152 illicit opioid users admitted to methadone maintenance were randomly assigned to fee or nofee status. The fee subjects were required to pay a fee of $2.50per day and the no-fee subjects were required to pay nothing. Elimination of fees significantly increased retention. Only 34% of the fee subjects but 54% of the no-fee subjects were retained for one year. Of those retained for one year, the fee subjects and the no-fee subjects showed only small and nonsignificant differences on urine test results and measures of social performance. Interviews per month with caseworker were inversely related to retention. Increased interviews and decreased retention may both have reflected treatment problems of subjects.

Consumer satisfaction with opioid treatment services at community pharmacies in Australia

“…This is consistent with the concerns of public clinics clients in NSW, many of whom reported that they could not afford pharmacy dispensing fees (32% of 432 clients) with the remainder reporting being able to afford a median of $10 each week [14]. The prohibitive cost of dispensing fees may impact on treatment retention [25]. In recognition of such concerns, the Australian Capital Territory (ACT) government subsidises Safe place to be dosed Fig.…”

Predictors of One-Year Retention in Methadone Maintenance Treatment (MMT) in Iran, Rafsanjan

“…Monthly treatment cost in private clinics is nearly three-fold as much as state clinics. Some studies found that treatment fee is associated with retention in MMT and fee-for-service methadone has poorer retention rates than free treatment (28, 43). Another explanation is that the state clinics’ clients are patients with low economical status who cannot afford opiates costs and these patients are forced to remain more in treatment and have more retention, not because of medical motivation but due to financial inability in affording opiates.…”

Treatment outcomes: First time versus treatment-experienced clients

“…The results of the study indicated that a more extensive treatment history was associated with more positive outcomes for clients in all modalities except LTR. Additionally, two earlier studies with clients treated in OMT found that clients with prior treatment experience had longer lengths of stay in OMT than clients with no prior treatment (Maddux, Prihoda, & Desmond, 1994;Simpson & Joe, 1993).…”

“…Additionally, Simpson, Savage, & Joe (1980) found that treatment-naRve clients were less likely to enter substance abuse treatment during a 3-year follow-up period than treatment-experienced clients, suggesting that a prior treatment history was associated with higher rates of relapse. Finally, several studies have found that prior treatment for opiate addiction is associated with continued drug use (Brewer, Catalano, Haggerty, Gainery, & Fleming, 1998) which seems at odds with prior treatment experience being associated with longer lengths of stay in OMT (Maddux et al, 1994;Simpson & Joe, 1993).…”