Addiction (Abingdon, England) 2016 9 23() doi 10.1111/add.13622
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.
Two-arm open-label randomized trial.
Two methadone treatment programs (MTPs) in Baltimore, Maryland, USA.
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.
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).
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.
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).
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.