Outcome predictors for patients receiving methadone maintenance treatment: findings from a retrospective multi-site study

Abstract

This study sought to determine whether select pre-treatment demographic and in-treatment clinical variables are associated with urinalysis drug screen (UDS) findings for opioids among patients receiving methadone maintenance treatment (MMT). Data were abstracted from electronic medical records for 2,410 patients admitted to 26 MMT programs from 2009–2011. Patients were studied through retrospective chart review for 12 months. UDS findings for opioids at 3-, 6-, 9-, and 12-month intervals were the outcome variables. Clinical variables included average daily methadone dosage and UDS findings for cocaine, amphetamines, cannabinoids, and benzodiazepines at intake and the various 3-month intervals. UDS+ for cocaine at intake and 3 months were found to be independent predictors of a UDS+ for opioids at 9 months. UDS+ for amphetamines and cannabinoids were found to predict UDS+ for opioids at various intervals. Higher daily methadone dosage was found to predict opioid abstinence at 9 months. Significant demographic predictors of UDS+ for opioids at various intervals included older age, unemployment, Hispanic ethnicity, and being male, single, separated, or non-self-pay. Overall, few of the demographic and clinical variables appear to provide a basis for a priori judgment about whether or not a patient presenting for MMT is likely to have a favorable long-term outcome. However, the findings do suffice to assist in making systematic improvements in MMT planning and in identifying particular subgroups of patients at risk for poor treatment response early on in the MMT process.