Methadone Maintenance Treatment Clinics Research Articles

Risk factors associated with continued heroin use during methadone maintenance treatment in Guizhou province, China

To investigate the proportion of methadone maintenance treatment (MMT) clients continuing to use heroin and to explore its associated risk factors. All 1003 heroin addictive patients were recruited from eight MMT clinics in Guizhou province and followed up for 14 months. During the 14 months, each MMT client received random urine tests. MMT clinics, gender, marital status, employment, ethnicity, religion, previous drug using method, having a history being in detoxification program, age, methadone dosage, education level and length of drug use were treated as potential predicting variables into the GEE model. The average age of the 1003 clients was (33.3 +/- 6.1) years old, the average length of drug use was (8.0 +/- 4.0) years, and the average daily methadone dosage was (38.0 +/- 16.6) mg. Among the 1003 clients, 26.0% were female drug users, 15.5% were divorced and 35.8% had a full time job. The rate of positive urine samples was approximately 30% for the first 10 months of follow-up, after which the positive rate decreased. The model found that different MMT clinics, the average daily methadone dosage (RR = 0.98, P = 0.003), treatment duration (RR = 0.95, P = 0.029) and years of education (RR = 0.94, P = 0.014) were associated with patients positive urine test. Continued heroin use was common in MMT clinics in Guizhou province; increasing the dosage of methadone and the duration in the treatment program might decrease the continued use of heroin among clients in MMT clinics.

Correlates of methadone client retention: A prospective cohort study in Guizhou province, China

Background Methadone client retention levels and treatment doses of patients vary widely in methadone clinics across China. Because methadone clinics have been available in China only recently, this study explored the relationship between methadone dosage and client retention in methadone maintenance programmes in Guizhou province. Methods The study used a prospective cohort study design. Injecting and non-injecting heroin-using clients who had been treated for no more than two and half months in one of eight methadone maintenance treatment clinics in Guizhou province were recruited into the cohort, beginning on 3 June 2006 and followed up until 1 June 2007. A total of 1003 participants were enrolled. Face-to-face interviews were conducted to collect baseline information, and clients’ daily doses were recorded. Results The 14-month retention rate was 56.2%. Controlling for other covariates in the multivariate Cox model, a higher methadone dose was found to predict higher client retention. Retention was also associated with intention to remain in treatment for life and the clinic attended. Conclusion Clients need to receive an adequate methadone dose to assure continued retention. Patients who expect to be treated for life have higher retention rates than patients who anticipate only short-term treatment. Key factors associated with successful clinics in China need to be elucidated.

One-Year and Cumulative Retention as Predictors of Success in Methadone Maintenance Treatment: A Comparison of Two Clinics in the United States and Israel

ABSTRACT Outcome predictors between two methadone maintenance treatment clinics in Tel-Aviv, Israel, and Las Vegas, Nevada, were determined by comparing patients' characteristics. All patients admitted to the two clinics (302 from Las Vegas and 492 from Tel-Aviv) were studied with respect to variables at admission and follow-up. Las Vegas patients were older, contained more females, had more hepatitis C positive markers, and more urine analyses that were positive for cocaine, amphetamines, and tetrahydrocannabinol (THC) on admission than the Tel-Aviv patients. After 1 year, Tel-Aviv patients had higher retention (73.6% vs. 61.6%) and similar opiate abstinence (65.8% vs. 64.9%) compared to Las Vegas patients. Predictors for cumulative retention (Cox regression) for both clinics were higher methadone dosages greater than or equal to 100 mg/day (Tel-Aviv OR [odds ratio] = 2.1, 95% confidence interval [CI] = 1.6–2.9; Las Vegas OR = 1.8, 95% CI = 1.3–2.5). Also, in Tel-Aviv, predictors were no opiate use after 1 year (OR = 1.7, 95% CI = 1.4–2.2) and no benzodiazepine after 1 year, and in Las Vegas no cocaine and no amphetamines after 1 year and age less than or equal to 30 years. The two major predictors in the two clinics were successful in both outcomes: 1 year retention and opiate abstinence.

Evaluation of ongoing oxycodone abuse among methadone-maintained patients

Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. This study presents results from an internal quality assurance project conducted by an outpatient methadone maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis-testing methods. One hundred five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic's usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, whereas the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration, and provide significantly more opioid- and cocaine-positive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. Although future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication-dosing decisions, and determining patient eligibility for methadone take-home privileges.

Implementing methadone medical maintenance in community-based clinics: Disseminating evidence-based treatment

Methadone medical maintenance (MMM) is an effective intervention that minimizes the demands of opioid agonist treatment without compromising good treatment response. Despite the benefits of MMM to both patients and treatment programs, little information is available to help community-based programs implement MMM and select patients who might benefit from this intervention. This study evaluates the impact of a seven-session seminar presentation combined with optional on-site consultation on subsequent changes in clinical programming and on the opinions of community-based treatment staff ( n = 96) in five methadone maintenance treatment clinics regarding both the adoption of an MMM protocol and the use of an adaptive stepped care model to deliver it. The presentations were developed based on results from a randomized clinical trial (King, V. L., Kidorf, M. S., Stoller, K. B., Schwartz, R., Kolodner, K., Brooner, R. K. (2006) A 12-month controlled trial of methadone medical maintenance integrated into an adaptive treatment model. Journal of Substance Abuse Treatment 31, 385–393.) together with other studies of MMM to help program staff (a) understand the risks and benefits of MMM, (b) develop criteria to choose who may benefit from MMM, and (c) implement an adaptive stepped care delivery system that includes MMM as the least restrictive level of care. A survey of clinic staff opinion about MMM and stepped care was administered at baseline and at five other points over the course of the 1-year project. Overall, the presentations were rated highly favorable for content and presentation (3.3 on a 4-point scale). At the 12-month follow-up, staff were more likely to believe that MMM facilitates patient participation in community-based rehabilitation oriented activities ( p = .026) and that MMM patients receive adequate counseling services ( p = .025) and were more likely to support treatment that matches patients who are stable with minimal intensities of care ( p = .041). One clinic modified its routine care to an adaptive stepped care model in response to the presentations, and 3 of the 5 clinics used MMM levels of treatment intensity at the end of the project. The results suggest that seminar presentations combined with on-site consultation may be a beneficial mechanism for helping staff at community-based programs learn about and adopt effective interventions developed and tested using rigorous research designs.

Socio-demographic and clinical characteristics of 3129 heroin users in the first methadone maintenance treatment clinic in China

Background This study aimed to determine the characteristics of heroin users in the first methadone maintenance treatment (MMT) clinic in China. Methods In a retrospective chart review, the notes of 3127 heroin users who received both detoxification and MMT at the clinic were analyzed. Their socio-demographic and clinical data were collected, and the frequency of human immunodeficiency virus (HIV), Hepatitis C virus (HCV), and syphilis infections was investigated. Results The main findings are as follows: (1) 66.5% of the patients were younger than 35 years; (2) 55.1% were married at admission; (3) 32% were non-local residents; (4) the majority had high school level education, a history of smoking and alcohol consumption prior to the initial heroin use, and did not have stable jobs; (5) 28.4% were self-employed; (6) 5.4% of the sample had total hearing loss coupled with loss of speech; (7) 83.4% sniffed heroin or injected it intravenously at the time of admission, but 87.2% had smoked the drug when they first began abusing it; (8) a significant proportion of the patients were infected with HIV, HCV, and syphilis. Conclusions Some of the above findings are not consistent with the results of previous studies conducted in Western countries and China. The unique socio-cultural and clinical characteristics of heroin abusers in different regions of China should be considered when MMT services are planned.

Effectiveness of first eight methadone maintenance treatment clinics in China

To evaluate the effectiveness of the first phase of eight methadone maintenance treatment (MMT) clinics in China. Repeated cross-sectional surveys. Three surveys of clients attending the first phase of eight MMT clinics were carried out at entry, and 6 and 12 months after enrolment. Drug using behaviours, drug-related criminal activity, and relationships with families were compared for the three periods. Blood specimen were collected and tested for HIV for each client at entry, and HIV-negative clients were re-tested after 12 months. A total of 585, 609 and 468 clients participated in the first, second and third surveys, respectively. The proportion of clients who injected drugs reduced from 69.1 to 8.9 and 8.8%, and the frequency of injection in the past month had reduced from 90 times per month to twice per month, employment increased from 22.9 to 43.2 and 40.6%, and self-reported criminal behaviours reduced from 20.7 to 3.6 and 3.8% in the three surveys. By the third survey, 65.8% of clients reported a harmonious relationship with families, an increase from 46.8% at entry, and 95.9% of clients were satisfied with MMT services. Eight HIV seroconversions were found among 1153 clients during 12 months. The study demonstrated that the first phase MMT contributed to a reduction in drug use, drug injecting behaviours, drug-related criminal behaviours, HIV infections, and improved relationships within families among heroin users who participated in the MMT programme. MMT needs to be scaled up nationwide rapidly with improved services.

Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: a double‐blind randomized clinical trial

To evaluate the effectiveness of melatonin in attenuating sleep difficulties during benzodiazepine (BDZ) withdrawal. Double-blind cross-over control study. Methadone maintenance treatment clinic. Eighty patients enrolled at a community methadone maintenance clinic recruited to a BDZ withdrawal programme. Melatonin (5 mg/day) or placebo: 6 weeks one arm, 1 week washout, 6 weeks other arm. Urine BDZ; self-reported Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies Depression (CES-D) questionnaires administered at baseline, and at 6, 7 and 13 weeks. Sixty-one patients (77.5% in the 'melatonin first' condition and 75% in the 'placebo first' condition) completed 6 weeks of treatment, showing a similar BDZ discontinuation rate of 11/31 and 11/30, respectively. PSQI scores were significantly lower (indicating better sleep quality) in the 22 patients who discontinued BDZ (8.9 +/- 0.9) than in 39 with urine BDZ (11.2 +/- 0.7, P = 0.04). Sleep quality in patients who continued abusing BDZ improved more in the 'melatonin first' group than in the 'placebo first' group, with no differences in sleep quality improvement in patients who stopped BDZ. CONCLUSION Most improvement in sleep quality was attributed to BDZ discontinuation. Although melatonin did not enhance BDZ discontinuation, it improved sleep quality, especially in patients who did not stop BDZ.

Rapid scale up of harm reduction in China

In the last 20 years, China has seen a resurgence in drug use, particularly heroin, and with it a growing epidemic of HIV/AIDS. Faced with this dual epidemic, the government has begun testing harm reduction strategies in recent years. These have included methadone maintenance treatment (MMT) programmes, needle–syringe programmes (NSP), outreach, and increasing access to HIV testing. MMT and NSP have moved from the pilot stage to scale-up, with 320 MMT clinics and 93 NSPs now open. Both will number more than 1000 by the end of 2008. There are some good examples of outreach programmes in some areas, however more needs to be done to facilitate greater involvement from non-government organizations. Similarly, HIV testing for drug users is widely available, but novel approaches to increasing its uptake need to be explored. Management of scale-up and reaching China's vast and dispersed drug-using population remain key challenges. The introduction of harm reduction has been a massive turn-around in thinking by the government, particularly law enforcement agencies, and achieving this has required considerable cooperation and understanding between the Ministries of Health, Public Security, and Justice, and the Food and Drug Administration. With their support, rapid scale-up to effectively reach a majority of drug users can be achieved in the coming years.

Characterization of Former Heroin Addict Patients With Hepatitis C Virus Antibodies in a Methadone Maintenance Treatment (MMT) Clinic in Israel

Aims: To compare characteristics, retention in treatment and cessation of drug abuse of 249 positive hepatitis C (HCV+) with 188 negative hepatitis C (HCV−) antibody patients. Methods: Data on Hepatitis C, Hepatitis B and HIV results, urine-proven drug use, and modified ASI of all patients admitted to the Adelson MMT clinic between June/1993–Dec/2002 were prospectively collected. Results: HCV+ patients manifested more ever injecting drug use, immigrants, positive HIV antibody, hepatitis B antigen, years of opiate addiction pre-MMT and benzodiazepines misuse after one year in MMT than HCV− patients, with similar 1-year retention and proportion of opiate use cessation. Conclusions: Although characteristics of HCV+ and HCV− differed, they manifested similar outcomes: treatment retention and proportion of opiate use cessation.

Gender Differences and Pregnant Women in a Methadone Maintenance Treatment (MMT) Clinic

We prospectively compared gender outcome among 470 MMT patients admitted between June 1993 and Dec 2002. Urine samples were analyzed for drug abuse after one month and after one year. On admission females 131(27.9%) were significantly younger (34.5 ± 7.5 years) than males 339(72.1%) (37.3 ± 8.3 years) (ANOVA;F = 11, p = 0.001) and had significantly higher cocaine abuse (20% vs. 11.3%) (Fisher's Exact Test, p = 0.02). After one year, groups had: (a) similar retention in treatment (76.3%-females, 72.6%-males), (b) stop in opiate abuse (65%-females, 65.3%-males), (c) a net decrease in cocaine abuse (% positive that became negative minus % negative that became positive) (68.0%-females, 51.6%-males). Females who were admitted to treatment while pregnant (n = 45) were significantly younger (31.5 ± 5.4 years) compared to 86 non-pregnant (36.1 ± 7.9, ANOVA F = 12.1, p = 0.001). We concluded that compared to males, females started MMT younger and had a higher proportion of cocaine abuse even though females' outcome were similar to males'.

Effects of Lower-Cost Incentives on Stimulant Abstinence in Methadone Maintenance Treatment

Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Factors predicting retention in treatment: 10-year experience of a methadone maintenance treatment (MMT) clinic in Israel

The aims were to identify predictors of treatment retention in an Israeli methadone maintenance treatment (MMT) clinic, and to compare the findings to other international settings. We prospectively studied 492 patients admitted since 1993 through 10 years to an Israeli MMT clinic associated with a university-affiliated tertiary care medical center. Analyses (Kaplan Meier and Cox regression) included methadone dose and urinalysis results (for methadone, cocaine, opiates, benzodiazepines, THC, amphetamines) of each patient in the first month and after 1 year in treatment (or during the last month if the stay was >3 months and <1 year) and patients’ characteristics (modified ASI). The 1-year retention rate was 74.4%; 65.8% stopped opiate abuse after 1 year in treatment. On admission, 13.6% of patients had used cocaine: there was a net decrease of 61.6% after 1 year. Factors predicting prolonged retention in MMT treatment (Cox regression) were daily methadone dose of 100 mg or greater, negative urine for opiates after 1 year, and being a parent on admission. We conclude that our good outcome results (high rate of retention after 1 year (74.4%), high proportion of opiate abuse cessation (65.8%), and net reduction in cocaine abuse, similar to normal standards in other MMT clinics elsewhere in the world, justify the expansion of the MMT clinic network in Israel in order to make treatment available to all those who need it. A protocol favoring higher methadone dosage as appropriate is recommended.

Methadone Clinics' Response to 9/11

Abstract In the aftermath of the September 11, 2001 attack on the World Trade Centers in New York City, medication delivery by methadone maintenance treatment clinics located in the surrounding area was temporarily disrupted. Clinics throughout the New York City area responded, providing medication and other services to patients from the affected clinics for up to 21/2 weeks. Lessons learned from this event resulted in recommendations for disaster planning that clinics throughout the nation may find helpful. New York's experience also highlights the value of patient awareness of dosage level when timely verification is difficult or impossible.

Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients

To characterize sleep disorders in methadone maintenance treatment (MMT) patients, we evaluated sleep quality of 101 non-selective patients from our MMT clinic in Israel between July, 2003 and July, 2004 by using the self-report questionnaire Pittsburgh Sleep Quality Index (PSQI). Patients’ urine tests were analyzed for methadone metabolite, opiates, benzodiazepine, cocaine, cannabis and amphetamines. Their urine results for drug abuse throughout the months prior to filling in the questionnaire and their maintenance methadone doses were recorded. Drug abuse was defined by at least one positive urine test. Methadone serum levels were available in 55 patients, assessed by Gas Chromatography Mass Spectroscopy. The patients’ self-reported chronic pain questionnaires and their diagnosed psychiatric disorders were analyzed. Out of the 101 study patients, 78.2% were male, 52.5% had psychiatric disorders, 46.5% reported having chronic pain and 46.5% had positive urine for benzodiazepine. The mean daily methadone dose was 157 ± 52.9 mg. The mean PSQI score was 9 ± 4.8 (75.2% had scores >5 indicating “poor sleepers”). PSQI scores were higher in patients with positive urine for benzodiazepine, chronic pain and psychiatric disorders and they correlated with years of opiate abuse before admission to MMT, and with the methadone dose ( r = 0.48, p < 0.0005). The latter two also correlated with each other. The PSQI was not correlated with duration in MMT, gender, age, abuse of opiates, cannabis or cocaine. We concluded that sleep disorders should be evaluated and treated among MMT patients, particularly in those with psychiatric disorders, benzodiazepine abuse, chronic pain and high methadone dose.

Self-Reported Effects of Methadone on Cigarette Smoking in Methadone-Maintained Subjects

Subjects maintained on methadone evidence a high level of interest in quitting cigarette smoking. Readiness to quit may result, at least partially, from direct pharmacological interactions between methadone and brain nicotinic acetylcholine receptors. The aim of the present study was to assess: (1) self-reported changes in smoking habits after admission to a methadone maintenance treatment (MMT) program; (2) acute effects of methadone administration on smoking behavior in MMT patients. The study was conducted between May and December 2001, in two public outpatient MMT clinics located in Warsaw, Poland. The patients (41 men, 30 women) reported smoking fewer cigarettes after admission to the program. Most subjects (67.6%) changed their favorite brand of cigarettes after admission. Mean nicotine content (mg/cigarette) significantly decreased. On the other hand, the subjects did not report any effects of methadone administration on smoking parameters. The above findings suggest that initiation of MMT is associated with positive changes in smoking behavior. However, these changes may not be related to direct pharmacological interactions between methadone and nicotine.

Significantly higher methadone dose for methadone maintenance treatment (MMT) patients with chronic pain

The aim of this study is to characterize patients with chronic pain in methadone maintenance treatment (MMT). Between September and December, 2003, 170 consecutive patients from an MMT clinic participated in a questionnaire survey on pain (duration and severity). Chronic pain was defined as current pain lasting for ≥6 months. The patients' maintenance methadone dosage and urine tests for drug abuse during the month before and of the survey were recorded. Of the 170 patients, 94 (55.3%) experienced chronic pain. They had a significantly higher proportion of chronic illness (74.5%) compared to non-pain patients (44.7%) (Fisher‘s Exact Test P<0.0005). Twelve (12.8%) of the chronic pain patients scored their pain as mild, 38 (40.4%) as moderate, 22 (23.4%) as severe and 22 (23.4%) as very severe. Pain duration significantly correlated with pain severity (Pearson R=0.3, P>0.0005) and was significantly associated with methadone daily dosage: patients with pain duration of ≥10 years ( n=26) were receiving the highest methadone dosage (182.1±59.2 mg/day), those with pain duration from 1 to 10 years ( n=59) 160.9±56.2 mg/day, and those with pain duration of <1 year ( n=9) 134.2±73.2 mg/day. Patients in the non-pain group ( n=76) were receiving 147.1±52.8 mg/day of methadone (ANOVA, F=3.1, P=0.03). We conclude that pain duration and severity significantly correlated. Although methadone was not prescribed for the treatment of pain but rather for opiate addiction, the patients in the MMT clinic with prolonged pain were prescribed a significantly higher methadone dosage compared to patients with short pain duration, and non-pain patients.

Cannabis abuse is not a risk factor for treatment outcome in methadone maintenance treatment: a 1-year prospective study in an Israeli clinic.

We addressed the following questions. What are the current and lifetime prevalence of cannabis abuse in an Israeli methadone maintenance treatment (MMT) clinic? Does cannabis abuse change over time during MMT? Is cannabis abuse related to treatment outcome measures such as retention rate and the abuse of drugs? Is the abuse of cannabis related to psychopathology, HIV/HCV risk-taking and infectious diseases? Do cannabis abusers (CAs) have a different psychosocial and demographic profile than nonabusers (NCAs)? Is cannabis abuse part of a polydrug abuse tendency or a distinct substance of abuse? Overlapping samples of either the entire clinic population (n = 283) or all the patients who had completed 1 year of MMT treatment (n = 196 of which 20 were re-entering) underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; HIV/HCV risk-taking behaviours; n = 164), interviews (ASI, n = 176; SCID, n = 151) and hepatitis C and HIV testing (n = 149). Lifetime abuse prevalence was found in 75% and current abuse at MMT intake in 25%. Abuse did not increase significantly over a 1-year period. Cannabis abusers were found to be more often polydrug abusers than NCAs. Cannabis abusers did not suffer from more psychological distress, infectious diseases, and did not engage in more HCV/HIV risk-taking behaviour, nor did they leave treatment earlier than NCAs. Cannabis abuse MMT patients should be treated as polydrug abusers, although no specific influences of cannabis abuse on psychological and medical conditions of MMT patients have been observed. Treatment policy should take these results into consideration.

Hepatitis C Virus and Human Immunodeficiency Virus-1 Co-Infection in Former Heroin Addicts in Methadone Maintenance Treatment

ABSTRACT Objectives: To investigate hepatitis C (HCV) and human immunodeficiency virus (HIV-1) prevalence in former opiate or heroin addicts currently in methadone maintenance treatment (MMT). Methods: Retrospective chart review for patients (n = 342) currently attending two MMT clinics affiliated with New York Presbyterian Hospital (Adolescent Development Program, ADP: n = 106, median age 30 years; Adult Clinic, AC: n = 236, median age 45 years), as of May 2000. Results: Overall seroprevalence of those tested was 67% for HCV (ADP, 44%; AC, 80%), and 29% for HIV-1 (ADP, 13%, AC, 39%). Co-infection was present in 26% of patients (ADP, 13%; AC, 35%). Prevalence of HCV reached 92% in the 45–49 year old group (n = 53). The greatest HIV-1 prevalence (45%) was in the 35–39 year old group (n = 33). There was a linear relationship between infection seroprevalence and age at admission into MMT. Conclusions: The high prevalence of HCV and HIV-1 infections in MMT patients varies both by current age and by age at admission to MMT. This population needs risk reduction education and treatment for HCV and HIV-1.

A naturalistic study on ending blind dosing in a methadone maintenance clinic in Israel

Since many methadone maintenance treatment (MMT) clinics in the United States do not share with patients, information concerning their methadone dosage, we aimed to investigate the impact of patients being informed of their methadone dosage and the influence of ending blind dosing on treatment outcome. Seventy-four patients who were unaware of their methadone dosage took part in this study. We compared changes in opiate abuse, levels of methadone dosage and patients’ perceptions of dosage adequacy before and after they were informed of their dosage. Data on opiate abuse were based upon bi-weekly randomly taken and observed urine tests provided the data on opiate abuse. Records on methadone dosage were kept and a short questionnaire on dosage-related attitudes, devised for this study, was administered. Most patients expressed the desire to know their dosage, but there were no significant changes in opiate abuse, methadone dosage or the patients’ perceptions of dosage adequacy after they knew what it was. We conclude that informing patients of their methadone dosage and thereby ending blind dosing does not seem to have any negative effect on treatment outcomes. We believe that this policy is in accord with the patients’ rights and expressed will to know their dosage and this justifies putting an end to blind dosing policies.