Methadone Maintenance Treatment Centers Research Articles

Retention and Relapse in Methadone Maintenance Treatment: A Descriptive Analytical Study

<p><strong>BACKGROUND:</strong> Despite the considerable efforts made in Iran to treat people with addiction, relapse is still common. This study was designed to determine retention and relapse rates and related factors at Yasin Methadone Maintenance Treatment Center.</p><p><strong>PATIENTS & METHODS:</strong> In this study, retention rate, relapse rate, and related factors were examined in 74 cases using a descriptive-analytical method. Information about 20 variables were gathered from patient medical records using an information form and a checklist and data was analyzed by the chi-square, Fisher’s exact, and Mann-Whitney tests using SPSS software.</p><p><strong>FINDINGS:</strong> The retention and relapse rates were 24.3% and 75.7%, respectively. Only three factors showed a significant difference (p<0.50) between the retention and relapse groups: (1) financial status, (2) motivation for treatment, and (3) cooperation during counseling (p=0.04, p=0.001, p=0.026, respectively). No significant differences were observed between groups for the other factors.</p><p><strong>CONCLUSION:</strong> Because it is clear that financial status, motivation, and counseling can affect retention rate, it is recommended to study the effect of these factors on retention using methods such as a randomized clinical trial.</p>

Hepatitis C Virus Treatment Access Among Human Immunodeficiency Virus and Hepatitis C Virus (HCV)-Coinfected People Who Inject Drugs in Guangzhou, China: Implications for HCV Treatment Expansion.

Background. Hepatitis C virus (HCV) treatment access among human immunodeficiency virus (HIV)/HCV-coinfected people who inject drugs is poor, despite a high burden of disease in this population. Understanding barriers and facilitators to HCV treatment uptake is critical to the implementation of new direct-acting antivirals.Methods. We conducted in-depth interviews with patients, physicians, and social workers at an HIV treatment facility and methadone maintenance treatment centers in Guangzhou, China to identify barriers and facilitators to HCV treatment. We included patients who were in various stages of HCV treatment and those who were not treated. We used standard qualitative methods and organized data into themes.Results. Interview data from 29 patients, 8 physicians, and 3 social workers were analyzed. Facilitators and barriers were organized according to a modified Consolidated Framework for Implementation Research schematic. Facilitators included patient trust in physicians, hope for a cure, peer networks, and social support. Barriers included ongoing drug use, low HCV disease knowledge, fragmented reimbursement systems, HIV exceptionalism, and stigma.Conclusions. Expanding existing harm reduction programs, HIV treatment programs, and social services may facilitate scale-up of direct-acting antivirals globally. Improving integration of ancillary social and mental health services within existing HIV care systems may facilitate HCV treatment access.

Exploring the social meaning of curing HIV: a qualitative study of people who inject drugs in Guangzhou, China.

Our objective was to explore the social meaning of HIV and perceptions of an HIV cure among people who inject drugs (PWID) in Guangzhou, China, which speaks to ethical and resource challenges to development in this field. We conducted a qualitative research study using in-depth interviews. We analyzed interview transcripts from 29 PWID, eight physicians, and three social workers from an outpatient HIV clinic and two methadone maintenance treatment centers. The social meaning of HIV infection and perceptions of an HIV cure reflected patients' relationships with society, health systems, and physicians. First, HIV infection decreased perceived social worth and disrupted peer relationships. The possibility of being cured renewed patient hope for regaining physical well-being and achieving social mobility. However, the existence of a cure may not alter the HIV-related stigma due to its association with stigmatized behaviors and marginalized groups. Second, although stigma was a significant barrier to engagement in health care, hope for a cure may outweigh fears of stigma and enhance linkage to HIV testing and treatment as well as methadone services. A cure may exacerbate perceived health disparities if inaccessible to key affected populations such as PWID. The social implications of an HIV cure among this key affected population may inform the design and implementation of cure clinical trials. Careful management of patient expectations, focusing research on key affected populations, expanding HIV testing and treatment systems, improving access to harm reduction programs, and ensuring post-trial access are important considerations for HIV cure research.

A Satisfaction Survey of Opioid-Dependent Patients with Methadone Maintenance Treatment

The aim of this study was to examine opioid-dependent patients' satisfaction with the methadone maintenance treatment (MMT) program in Malaysia and identify predictors of satisfaction. We used an interviewer-administered questionnaire developed and validated by Rankin Court, New South Wales, Australia. Of 502 patients approached in 11 MMT centers in Malaysia, 425 agreed to participate giving a response rate of 85%. In terms of overall satisfaction, a high percentage of respondents (85%) were satisfied with the MMT services. A logistic regression analysis showed that only “centres” and marital status were associated with overall satisfaction and that being single (OR 3.31; 95% CI 1.52 to 7.20) or married (OR 4.06; 95% CI 1.76 to 9.38) was associated with higher odds of overall satisfaction compared to being divorced or separated. An analysis of the responses pertaining to the most desired changes required at the center found dosing hours, waiting area and staff shortages to be common. The findings acquired from this survey will be useful to attain a clearer perspective on what aspects of the MMT service need to be reviewed for the improvement of service delivery.

Cost-effectiveness of Methadone Maintenance Treatment in Prevention of HIV Among Drug Users in Shiraz, South of Iran

Background:The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS.Objectives:This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users.Materials and Methods:In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER).Results:Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $ 547423 and that of HIV/AIDS care in the no intervention scenario was estimated $ 14171816. ICER was $ 106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from $ 39149 to $ 290004 per HIV case averted.Conclusions:With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable.

Substance abuse and the HIV situation in Malaysia

Heroin continues to be the main drug used in Malaysia, whereas amphetamine-type stimulants (ATSs, such as ecstasy, syabu, and yaba) have been recently identified as a growing problem. A cumulative total of 300,241 drug users were detected between 1988 and 2006. It is also estimated that Malaysia has 170,000 injecting drug users. Human immunodeficiency virus (HIV) prevalence among drug users in the country ranges from 25% to 45%. Currently, there are approximately 380 general medical practice offices that offer agonist maintenance treatments for approximately 10,000 patients. There are 27,756 active patients in 333 general medical practice offices and government-run methadone maintenance treatment (MMT) centers. The needle syringe exchange program reached out to 34,244 injection drug users in 2011. In the past 2 years (2011 and 2012) the number of detected drug addicts decreased from 11,194 to 9015. The arrests made by the police related to opiate and cannabis use increased from 41,363 to 63,466 between the years 2008 and 2010, but decreased since 2010. An almost four-fold increase in the number of ATS and ketamine users was detected from 2006 (21,653 users) to 2012 (76,812). Between 2004 and 2010, the yearly seizures for heroin ranged from 156 kg to 270 kg. However, in 2010 and 2011, heroin seizures showed a significant increase of 445 kg and 410.02 kg, respectively. There has been a seizure of 600–1000 kg of syabu yearly from 2009 to 2012. Similar to heroin, increased seizures for yaba have also been observed over the past 2 years. A significant increase has also been recorded for the seizures of ecstasy pills from 2011 (47,761 pills) to 2012 (634,573 pills). The cumulative number of reported HIV infections since 1986 is 94,841. In 2011, sexual activity superseded injection drug use as the main transmission factor for the epidemic. HIV in the country mainly involves males, as they constitute 90% of cumulative HIV cases and a majority of those individuals are IDUs. However, HIV infection trends are shifting from males to females. There are 37,306 people living with HIV who are eligible for treatment, and 14,002 people living with HIV were receiving antiretroviral treatment in 2011. The decreasing trend of heroin users who have been detected and arrested could be due to the introduction of medical treatments and harm reduction approaches for drug users, resulting in fewer drug users being arrested. However, we are unable to say with certainty why there has been an increase in heroin seizures in the country. There has been an increasing trend in both ATS users and seizures. A new trend of concurrent opiate dependence and ATS underscores the need to develop and implement effective treatments for ATS, concurrent opiate and ATS, and polysubstance abuse disorders. The low numbers of needle syringe exchange program clients being tested for HIV underscores our caution in interpreting the decline of HIV infections among drug users and the importance of focusing on providing education, prevention, treatment, and outreach to those who are not in treatment.

Latent and Active Tuberculosis: Evaluation of Injecting Drug Users

BackgroundThere is a high risk of tuberculosis (TB) infection among injecting drug users (IDUs).ObjectivesThis study aimed to determine the frequency of latent and active TB infection among IDUs.Materials and MethodsIn a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (> 5 mm and > 10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test.ResultsOverall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs. 18.5%). An active TB was found among IDUs.ConclusionsThe high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.

Dose-Dependent Effects of Methadone on QT interval in Patients under Methadone Maintenance Treatment

Background: The role of methadone in QTc prolongation, Torsades de Pointes (TdP) arrhythmia and sudden cardiac death has been debated. Because of widespread use of methadone in methadone maintenance treatment (MMT) centers, we aimed to study dose-related effects of methadone on QTc prolongation. Methods: In a comparative observational study, 90 patients who were under MMT were evaluated. Patients were divided into three groups according to methadone daily dose (G1: 0-59 mg, G2: 60-109 mg, G3: 110-150 mg). Twelve-lead electrocardiograms (ECG) were performed at baseline and two months later, after reaching the maximum daily dose of methadone. The QTc were calculated for each patient. Comparison of mean QTc and mean QTc prolongation between baseline and follow up ECGs were analyzed. Results: In total, mean (SD) age was 32.4 (8.5). TdP was not detected in any patients. Mean QTc was 405.2 (17.0) and 418.5 (23.1) msec before and two months after MMT respectively. There was a significant difference between mean QTc in each group before and after treatment (P<0.001). In total, mean QTc prolongation was 13.5 (8.1). Univariate analysis showed that there was a significant difference in means of QTc prolongation between G1 and the other two groups (P=0.001), but not between G2 and G3. This indicates that patients receiving methadone over 60 mg/day are at a risk of greater QTc prolongation. Conclusion: Methadone can cause QTc prolongation in different doses. However, the extent of this effect is dose dependent. Daily dose of less than 60 mg methadone is a safer cardiac dose. Nevertheless, it is not possible to administer this low dose for all opioid addict patients. Therefore, it is necessary to closely monitor patients under MMT, especially those receiving higher methadone doses, with constant scheduled ECGs before and during treatment.

The necessity of checking the status and performance of methadone maintenance treatment centers in iran.

The necessity of checking the status and performance of methadone maintenance treatment centers in iran.

Sexual dysfunction in male crystalline heroin dependents before and after MMT: a pilot study.

Sexual dysfunction (SD) is a common problem among chronic opiate dependents. The purpose of this study is to examine the prevalence of SD and to investigate whether there is a change in SD after six months of methadone maintenance treatment (MMT) compared with baseline. We recruited 30 patients mean age 34.5 years from an MMT center in Damghan, Iran. Patients underwent structured interviews that consisted of the following: (i) socio-demographic characteristics, drug use, and sexual behavior ; (ii) the International Index of Erectile Function (IIEF-15) test for SD; (iii) the Zung test for depression; and (iv)analysis of serological status. Overall, 8% of participants reported no SD, 69% reported mild to moderate SD, and 23% reported severe SD upon admission. After completion of the MMT program, these results decreased to 61% and 20%, respectively. In comparison with admission, the mean IIEF-15 score showed moderate improvement from 16.77 ± 7.08 to 21.8 ± 6.40 (P = 0.003). The mean IIEF-15 score for intercourse satisfaction completely improved from12.20 ± 4.55to 15 ± 3.76 (P = 0.001). Slight improvements were noted in the mean IIEF-15 score for sexual desire which increased from 5.10 ± 2.28 to 6.57 ± 2.12 (P = 0.017) and the mean IIEF-15 score for overall satisfaction which increased from 5.10 ± 2.29 to 6.58 ± 2.12 (P = 0.017). However, the mean IIEF-15 score for orgasmic function very slightly decreased from 4.73 ± 4.50 to 4.57 ± 1.92 (P = 0.191), which showed no statistically significant improvement after MMT. There was no relation with depression. The findings of this study reveal a prevalence of SD and improvements in some aspects of SD in patients after six months of MMT. Patients should be screened for SD at the onset of opioid replacement treatment. Future studies on SD should examine the potential benefits of androgen replacement, hormone assay and the role of psychosocial factors.

Use of a ‘microecologic technique’ to study crime incidents around methadone maintenance treatment centers – a response

Use of a ‘microecologic technique’ to study crime incidents around methadone maintenance treatment centers – a response

A 12-Month Evaluation of Health-Related Quality of Life Outcomes of Methadone Maintenance Program in a Rural Malaysian Sample

This paper focuses on the evaluation of addiction program effectiveness which involves changes in health-related quality of life (HRQoL) profile. This study was conducted from 2007 until 2010 at a rural methadone maintenance treatment center in Malaysia to assess HRQoL outcomes before and after treatment. Fifty-seven respondents completed the WHOQOL-BREF at baseline, 6 months, and 12 months postintervention. Data were analyzed using nonparametric techniques (SPSS 15). Significant and positive HRQoL impacts were demonstrated. Future studies with larger sample are encouraged. This study was supported by the Ministry of Health Malaysia.

Use of a ‘microecological technique’ to study crime incidents around methadone maintenance treatment centers

Concern about crime is a significant barrier to the establishment of methadone treatment centers (MTCs). Methadone maintenance reduces crime among those treated, but the relationship between MTCs and neighborhood crime is unknown. We evaluated crime around MTCs. Baltimore City, MD, USA. We evaluated crime around 13 MTCs and three types of control locations: 13 convenience stores (stores), 13 residential points and 10 general medical hospitals. We collected reports of Part 1 crimes from 1 January 1999 to 31 December 2001 from the Baltimore City Police Department. Crimes and residential point locations were mapped electronically by street address (geocoded), and MTCs, hospitals and stores were mapped by visiting the sites with a global positioning satellite (GPS) locator. Concentric circular 'buffers' were drawn at 25-m intervals up to 300 m around each site. We used Poisson regression to assess the relationship between crime counts (incidents per unit area) and distance from the site. There was no significant geographic relationship between crime counts and MTCs or hospitals. A significant negative relationship (parameter estimate -0.3127, P < 0.04) existed around stores in the daytime (7 am-7 pm), indicating higher crime counts closer to the stores. We found a significant positive relationship around residential points during daytime (0.5180, P < 0.0001) and at night (0.3303, P < 0.0001), indicating higher crime counts further away. Methadone treatment centers, in contrast to convenience stores, are not associated geographically with crime.

Drug Abuse Pattern and High Risk Behaviors among Addicts in Shahroud County of Semnan Province, Northeast Iran in 2009.

This study aimed at determining the drug abuse pattern and the frequency of high-risk behaviors among the clients of Methadone Maintenance Treatment Centers and Drop-in Centers in Shahroud County of Semnan Province. In this cross-sectional study, the data collection tool was a questionnaire including 10 general and 32 specific items about drug abuse pattern and high-risk behaviors. The data were collected via interview. The mean age of the subjects was 34.8 year. The patterns of opium consumption among the subjects before coming to treatment center were inhalation (44.4%), ingestion (25.7%), and injection (12.7%). The subjects abused different types of opium before referring to the treatment centers including opium 88.42%, opium extract 65.5%, crack 48.0%, alcohol 30.3%, cannabis 19.8%, heroin 16.7%, and other substances 6.5%. Almost 42.4% of subjects had positive family history of drug abuse. There was not statistically significant correlation between the form of substance abuse and gender, education level, occupation and marital status. However the correlation between form of substance abuse and place of residence (P=0.014), income (P=0.03) and tobacco smoking (P=0.001) was statistically significant. The most prevalent pattern of drug consumption was inhalation. Opium and crack were the most frequent kind of drugs among study subjects. These results need serious attention in providing services through Methadone Maintenance Treatment Centers as well as Drop-in Centers. In addition, due to highly positive family history among addicts, family participation will play an important role in prevention.

15-Year survival and retention of patients in a general hospital-affiliated methadone maintenance treatment (MMT) center in Israel

We have extended our previous 10-year follow-up study of MMT retention for another 5 years and added data on survival of all patients ever admitted to our MMT clinic (6/1993 to 6/2007). Data were calculated from admission to MMT until leaving, death, or study closure (6/2008). Ninety-four of a total of 613 patients (4711.6 person-years [py]) died. Cancer was the primary cause of death for those who remained in treatment, and overdose for those who left MMT. Longer survival ( p = 0.051) with a trend for a lower mortality rate ( p = 0.08) was noted among the 464 patients who stayed in treatment ≥1 year (1.8/100 py), compared with the 149 patients who left MMT <1 year (2.6/100 py). Predictors of survival in multivariate analyses were younger age (<40 years) at admission, living with a spouse/partner, being hepatitis B sera-negative, not abusing benzodiazepines on admission (interaction effect), not being referred directly from hospitalization to MMT, and not leaving the MMT program for hospitalization. The two latter variables also predicted longer retention, as did a high methadone dose (≥100 mg/d), no opiate and, no benzodiazepine abuse after 1 year and either having any DSM-IV-TR Axis I, or no Axis I&II psychiatric diagnoses. Unlike retention, mortality was associated with pre-treatment severity and comorbidities thus only partially reflects MMT outcome (opiate abstinence and treatment success). Benzodiazepine abuse reduced both retention and survival, emphasizing the high priority that should be given to stopping it.

Wound-Evidence-Based Interventions

PURPOSE: This study examined the occurrence of peripheral arterial disease (PAD) and risk factors for its development in persons in illicit drug treatment. METHODS: A stratified cross-sectional design was used to insure age, gender, and ethnic (Black vs. White) balance with respect to three main drug use categories (arm injectors only; arm + leg injectors; noninjectors). Participants (N = 640) were obtained from 10 methadone maintenance treatment centers in the United States. Assessments included demographic, health, and illicit drug use history questionnaires, the Walking Impairment Questionnaire, the Positive Attitude Toward Physical Activities/Exertion Questionnaire, and body mass index. PAD was defined as an ankle brachial index of less than 0.90 in at least one leg. RESULTS: PAD was identified in 16.7% of participants; the mean (SD) ankle brachial index value for persons with PAD was 0.84 (0.05). Multiple logistic regression analysis found sex (women) (OR = 2.10) history of ever smoking cigarettes (OR = 5.16), years of smoking cigarettes (OR = 1.60 per 10 years smoking) and having a positive attitude toward physical activities/exertion (OR = 0.63) made significant contributions to the predictors for PAD controlling other background and risk variables. CONCLUSIONS: A high risk of PAD is present in persons in drug treatment and should be assessed. Smoking cessation should be encouraged. FUNDING: National Institute of Nursing Research/National Institute of Health (NINR/NIH), R01 NR009264.

Chronic Venous Disorders and Injection Drug Use

Injection drug users are at high risk for chronic venous disorders (CVD), a condition resulting in a progressive deterioration of venous function of the legs. However, the effects of CVD on walking mobility in this population have not been studied. We examined a causal model of the relationship between injection drug use, CVD, and Walking Mobility. The validity of the Tinetti Balance and Gait scales and walk speed as a composite measure of Walking Mobility was also explored. The participants were 104 men and women from a methadone maintenance treatment center. Drug use included 18 persons who injected drugs only in the hands, arms, and above the waist; 70 who injected all over the body including the lower extremities; and 16 who never injected drugs but used illegal substances by other routes. Forty-nine percent of participants had moderate to severe CVD. Participants were classified into 2 groups according to their history of injection drug use: (a) those who injected in the lower extremities (n = 70) and (b) those who injected in the arms plus those who did not inject (n = 34). All measurements were obtained at baseline and again approximately 6.5 weeks later. Structural equation modeling was used to examine the causal effect of CVD on Walking Mobility. The validity of the Balance and Gait scales and the walk time variable as measures of a Walking Mobility factor was examined using a second-order confirmatory factor analysis. Questionnaires included the Demographic and Health History and Drug History. The lower extremities were evaluated with the clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology classification. Participants completed the Tinetti Balance and Gait test. A timed 6-m walk at the person's normal pace was used to calculate walk speed. Test-retest reliability of the Tinetti Balance and Gait test and walk speed ranged from 0.79 to 0.86. Balance and gait scores were skewed toward the high end of the scale. Walking speed was slow. The leg-injecting group had lower Balance (P < .05) and Gait (P < .01) scores. A structural equation modeling showed that CVD was related to Walking Mobility after controlling for age, gender, body mass index, and comorbidities. Injection drug use and age were linked to Walking Mobility through CVD severity. Although fall information was not collected as part of our study, 15% of participants had a Tinetti score of less than 19, indicating a high risk for falls. Tinetti Balance and Gait scales and walking speed are reliable and valid measures for the evaluation of walking mobility among persons with a history of drug use. Further research is needed to alleviate the impact of venous disease on walking mobility.

Effects of Injection‐Drug Injury on Ankle Mobility and Chronic Venous Disorders

To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use. The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center. Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity. Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility. Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.

Smoking cessation patterns in methadone-maintained smokers

To determine predictors of smoking cessation duration in a randomized clinical trial, we assigned participants to nicotine patch (8-12 weeks) plus either (a) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session, or (b) brief advice using the National Cancer Institute's 4A's model. A total of 383 smokers from five methadone maintenance treatment centers in Rhode Island were enrolled, of whom 312 (82%) completed 6-month follow-up assessments. The primary outcome was longest period of self-reported abstinence during follow-up. Participants were on average 40.5 years of age; 51.9% were male, and 77.6% were White. In multivariate analysis controlling for demographics, nicotine dependence, depressive symptoms, and smoking-related symptoms, we found longer periods of abstinence in persons reporting at least one 24-hr quit attempt in the year prior to baseline (OR = 1.97, p = .003), in those anticipating success in cessation (OR = 1.33, p = .024), and in those with a greater percentage of nicotine patch use days (OR = 2.78, p<.001). Past quit attempts, self-efficacy, and constant nicotine replacement were associated with duration of abstinence among methadone-maintained smokers. Attention to these domains in future intervention studies may improve treatment success.

A smoking cessation intervention for the methadone‐maintained

To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored behavioral treatment over a minimal treatment for smoking cessation. Randomized clinical trial with 6-month follow-up. Five methadone maintenance treatment centers in Rhode Island. Three hundred and eighty-three methadone-maintained smokers. Participants were assigned randomly to nicotine patch (8-12 weeks) plus either (1) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session and a relapse prevention follow-up session (Max) or (2) brief advice using the National Cancer Institute's 4 As model (Min). An intent-to-treat analysis with those lost to follow-up assumed to smoke was used. Carbon monoxide (CO)-confirmed 7-day point smoking cessation prevalence at 3 and 6 months, and self-reported numbers of cigarettes smoked per day. Participants had a mean age of 40 years, were 53% male, 78% Caucasian, smoked 26.7 (+/- 12.2) cigarettes/day and had a mean methadone dose of 95.5 mg. At 3 months, 317 (83%) were re-interviewed; at 6 months, 312 (82%) were re-interviewed. The intent-to-treat, 7-day point prevalence estimate of cessation was 5.2% in the Max group and 4.7% in the Min group (P=0.81) at 6 months. In logistic models with treatment condition, age, gender, race, Fagerström Test for Nicotine Dependence and cigarettes per day as covariates, males were more likely to be abstinent at 3 months (OR 4.67; P=0.003) and 6 months (OR 4.01; P=0.015). A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone-maintained smokers are low, with men having greater success.