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Patient-Centered Methadone Treatment: A Randomized Clinical Trial.

Patient-Centered Methadone Treatment: A Randomized Clinical Trial.
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Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Gandhi D, Olsen Y, Jaffe JH,


Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Gandhi D, Olsen Y, Jaffe JH, (click to view)

Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Gandhi D, Olsen Y, Jaffe JH,

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Addiction (Abingdon, England) 2016 9 23() doi 10.1111/add.13622

Abstract
BACKGROUND AND AIMS
Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12-months following admission, compared with methadone treatment-as-usual.

DESIGN
Two-arm open-label randomized trial.

SETTING
Two methadone treatment programs (MTPs) in Baltimore, Maryland, USA.

PARTICIPANTS
300 newly-admitted MTP patients were enrolled between September 13, 2011 and March 26, 2014. Their mean age was 42.7 years (SD = 10.1) and 59% were males.

INTERVENTION
Newly-admitted MTP patients were randomly assigned to either Patient-centered Methadone Treatment (PCM; n = 149) which modified the MTP’s rules (e.g., counseling attendance was optional) and counselor roles (e.g., counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151).

MEASUREMENTS
The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior, and quality of life, and retention in treatment.

FINDINGS
There were no significant differences between PCM and TAU conditions in opioid-positive urine screens at 12-months (P = 0.65; 95% Confidence Interval (CI): -0.10, 0.15). There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI: 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05).

CONCLUSIONS
Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.

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