Methadone Substitution Therapy Research Articles

Rehabilitation of Drug Users in Makassar City

The spread and abuse of narcotics is a complex problem, which requires comprehensive mitigation efforts involving multidisciplinary, multisectoral cooperation and active community participation carried out continuously, consistently and consistently. Even though in medical science, most classes of narcotics are still useful for treatment, if they are misused or used not according to medical indications or treatment standards, especially if accompanied by illegal distribution, it will have very detrimental consequences for individuals and society at large. The cumulative number of AIDs cases in Indonesia in the second quarter of 2010 was 21,770 cases. The spread of HIV/AIDS among Injection Drug Use/IDUs has reached 8,795 cases. Methadone substitution therapy needs to be carried out with the aim of reducing adverse health, social and economic impacts, reducing the risk of contracting and transmitting HIV to other people, however therapy failure often occurs due to non-compliance or poor adherence. The research is observational with a cross sectional approach. Data were collected using questionnaires through interviews with informants following the therapy program. The results of the study showed good compliance in following therapy. Factors related to compliance in therapy are knowledge, attitudes, motivation, self-efficacy, family role, peer role, and health worker role. Multivariate analysis of multiple Logistic Regression, the most influential factors are motivation and the role of peers.

Phenibut intoxication in a patient on methadone substitution therapy: A case report

IntroductionPhenibut is a synthetic γ-aminobutyric acid (GABA) agonist used to treat symptoms of mental disorders like anxiety and insomnia. The substnce is licensed and widely used in Russia. Its recreational use is increasing in many countries as it is easily accessible online. In a recent years, several case reports of phenibut intoxication and withdrawal have been published worldwide.ObjectivesWe present a case report of intoxication with phenibut in a patient with psychoactive substances use disorder on regular methadone substitution therapy.MethodsA 40-year-old male was hospitalized for the first time in the psychiatrc ward due to intoxication with phenibut. Before admission, he was confused, with incoherent speech. Bradypnea and somnolence were observed. A urine screening test was positive for methadone and benzodiazepines, while there was no information on phenibut intake at that time. After receiving naloxone, the patient became, agitated and haloperidol was introduced.ResultsThe main symptoms of phenibut intoxication, which have also been described in other cases, are cardiovascular effects, insomnia, anxiety, agitation, hallucinations, and reduced level of consciousness. In our case, a more heterogeneous clinical picture of intoxication was observed, due to the simultaneous use of methadone and other PAS.ConclusionsThe availability of various synthetic substances available online is constantly increasing. Their use is most common in the population with substance use disorders, in patients on substitution therapy and in patients with mental disorders in general. The clinical picture of intoxication can thus be very diverse and atypical, which requires increased attention from clinicians.Disclosure of InterestNone Declared

HEPATITIS B, HEPATITIS C AND HIV AMONG DRUG USERS IN METHADONE MAINTENANCE TREATMENT: PREVALENCE, DOSES, TREATMENT COMPLIANCE

TheUsersofopioidsubstances,especiallyinjectingdrugs,areathighriskofinfection with blood- borne viruses,such as hepatitis B,C and human immunodeficiency virus, due to the sharing of needles and injection equipment. Methadone substitution treatment is approven device in the risk reduction strategy of hepatitis B,C and HIV infection.The aim of this studyis to determine: the socio-demographic and medical psychiatric characteristics of patients with hepatitis B,C and HIV under methadone,the prevalence of hepatitis C,B and HIV,the dose of methadone and compliance with treatment in this population. Materials and methods: This is a retrospective descriptive study of patients admitted to the center of addictology at the hospital Ar-razi of Sale in Morocco , specifically in methadone unit. Results: The prevalence of hepatitis C, B and HIV were respectively 80%, 13% and 4% in patients with positive serology, the average dose of methadone was higher than the dose of all patients enrolled in the methadone program. 80% of patients under methadone with positive serology to HCV, HBV and HIV had a polyconsumption of psychoactive substances (cannabis, cocaine, alcohol, benzodiazepine). 72% of our patients with hepatitis C received treatment for their infection while all the patients with HIV were put on antiretroviral drugs with good therapeutic compliance. Conclusion:Methadone substitution therapy has proven to be a successful strategy to reduce the risk of HIV, HCV and HBV infection in opioid-dependent patients. However, the adjustment of methadone doses and systematic screening for HIV, HCV and HBV is essential in this vulnerable population.

Supstituciona terapija metadonom - dijagnostički izazovi u ordinaciji lekara opšte medicine

Introduction. Opioid addiction is a chronic condition related to different morbidities. The methadone substitution therapy of the opioid addict, combined with social, health, and psychological services is a gold standard of the treatment. All opioids display numerous side effects. Kidney damage in opioid addicts is due to sepsis, rhabdomyolysis, decreased glomerular filtration, hypotension, pulmonary edema, renal lipidosis, or amyloidosis. Case report. The male patient, 40, on methadone substitution therapy feels weak, sweats excessively. Lab work: potassium 9.87 mmol/L, BUN 18.3 mmol/L, creatinine 268 µmol/L, urea clearance 0,20 ml/s, creatinine clearance 0,81 ml/s, eGFR 23 ml/min/1,73m2 , creatine phosphokinase 1180 IU/L, Hgb 79 g/L, Er 2.81x1012/L, C-reactive protein 13.2 µg/ mL, Le 7.41x109 /L, PCO2 41 mmHg, HCO3 22 mmol/L, and acidosis, pH 7.21. Blood pressure 130/80 mmHg and heart rate 64 bpm, ECG shows prolonged PR interval and high T waves. He was treated with crystalloid IV solutions, 8.4% bicarbonate solutions, diuretics, calcium gluconate, short-acting insulin, antibiotics, and anticoagulants. After therapy, there is an improvement in his potassium levels, diuresis, and ECG. After 24 days of hospital treatment, he was discharged to home care. Conclusion. Patients on methadone substitution therapy have a higher risk of multiple organ damage. Kidney function is especially at risk. It is of utmost importance to raise awareness among physicians of the danger of rabdomyolysis in these patients. Regular lab checks in patients on methadone substitution therapy can timely detect severe acute and chronic kidney complications and enable timely treatment.

Resocialization as prevention of deviant behavior in the Socialist Republic of Vietnam: a review of legislation and practice

The Vietnamese government has set the task of creating a prosperous people and a strong, democratic society, a just and civilized country. This task cannot be achieved without a sound domestic policy that includes the fight against anti-social phenomena such as domestic drunkenness, chronic alcoholism, and drug addiction as an essential component, which create the ground for criminogenic behavior. The Objective of the study is to study the basic acts of Vietnamese legislation on the regulation of the prevention of deviant behavior among alcoholics and drug addicts and the resocialization of persons who committed crimes and are in prison, as well as those released from them. The general methodological basis is represented by the dialectical method, which allowed studying the research object in development to establish the corresponding cause-and-effect relationships. The authors used general scientific methods, including analysis and synthesis, induction, and deduction methods, to obtain reliable and scientifically significant results. Attention is drawn to the specific methods of resocialization combined with methadone treatment for drug addicts in the Socialist Republic of Vietnam, the conditions and regime of such treatment, and specific individuals’ responsibilities. In the twenty-first century, there are gradual changes in the worldview of the political leadership and the legal practice of Vietnam concerning people with addictions that can be treated and corrected. This has led to the adoption of evidence-based resocialization methods, particularly the use of methadone substitution therapy for drug addicts. Russian scientists are actively engaged in the problem of resocialization in the context of Russian criminal law issues. This article is the first to raise the issue of the Vietnamese approach, information about which is taken from sources in the Vietnamese language.

Neonatal abstinence syndrome in a newborn delivered by an opioid-dependent mother using methadone substitution therapy during pregnancy

Introduction. Psychoactive substances as opioids used by women during pregnancy can have a negative impact on the health of a newborn child. Case report. Based on a case report of a newborn delivered by an opioid-dependent mother, this article describes the therapeutic decision-making that occurred in caring for this patient. This included outlining the form of substitution therapy selected and the use of Finnegan’s scoring system to assess the degree of abstinence syndrome in the newborn. Conclusion. There is a need to monitor drug-dependent women and their children from the early stages of pregnancy through to birth to ensure positive health outcomes for both the mother and the newborn.

Developing a new cohort of children born to women who used opioids in pregnancy using administrative data: insights into cohort creation and early results

Background with rationaleChildren born to opioid-dependent mothers are at a developmental disadvantage from pre-birth. They are additionally affected by the mother’s compromised ability to recognise and respond to the infant’s cues. Development is often compounded by environmental factors. Research to date has primarily focused on early infancy and small, clinical samples. This group is difficult to follow-up using traditional methods due to chaotic home environments, housing instability and parent-child separation. The use of administrative data circumnavigates such difficulties, allowing follow-up of children over longer periods, even when removed from the birth parent.
 Main AimThis paper will describe the complex creation of a cohort of children born to opioid-dependent women, using administrative data. It will also describe early results about pregnancy and neonatal outcomes.
 Methods/ApproachData were pooled from women who gave birth between 2007 and 2017 using five datasets (c.5,000 women): women who were recorded as using heroin, street methadone or opioid substitution therapy (OST) on the Drugs Misuse Database, or on OST prescription records; women admitted to hospital, or psychiatric care, for an opioid related reason; and/or women whose children were recorded as having Neonatal Abstinence Syndrome (NAS). Data on children’s neonatal outcomes will be described, including birth weight and gestation, congenital abnormalities, neonatal death and NAS treatment. Models will be fitted to investigate the associations between possible teratogenicity of prenatal opioids and developmental outcomes.
 ResultsThe development of this cohort using administrative data sources has been complex, requiring five different datasets to ensure all women of interest are captured. Descriptive results on outcomes will be available in the Autumn.
 ConclusionThis administrative data study demonstrates the value of using linked data sources to enhance our knowledge of the trajectories of this vulnerable group of children, and the additional support that they, and their carers, may require.

Methadone Maintenance Treatment: A 15-year Retrospective Study in Split-Dalmatia County, Croatia.

The aim of this retrospective study is to use existing epidemiological data on patients in methadone maintenance treatment in Split-Dalmatia County from 2001 to 2015 to evaluate the substitution treatment system and policy of opiate addicts treatment, the epidemiological trend, and risk of overdose mortality. In addition, we would like to highlight the problem of poor control of methadone therapy and thus the possibility of selling methadone. The result is a greater number of deaths caused by methadone in people who were not in methadone therapy. The research included data collected from 3189 patients who had been in the drug abuse treatment program in Split-Dalmatia County during 2001-2015 and data gathered from autopsy examinations of patients in Split-Dalmatia County with emphasis on data for 186 overdosed patients during research period. The total number of patients in the methadone treatment program in Split-Dalmatia County during the research period, except in 2005 and 2006, has been stable, while the number of new opiate patients, being in first-time treatment, decreased by 62.5%. The number of addicts who were in a long-term maintenance program has increased by 198%, whereas the number of addicts who were in a short-term detoxification treatment has decreased by 96.4%. According to results obtained from performed autopsies, 186 death cases were determined as overdoses. Methadone was found in 56 of those cases and was declared as the cause of death in 39 cases (70%). Of the total number of autopsied patients with diagnosed methadone overdose, only 23 (59%) had been recorded to receive methadone therapy in Public Health Institute of Split-Dalmatia County database. The results of this study show the favorable epidemiological trend because of the decreasing number of new opiate patients in treatment. The retention of opiate patients in substitution therapy indicates the effectiveness of methadone maintenance programs. Our research did not determine any influence of methadone substitution therapy on an increasing risk of specific (overdose) mortality.

Itraconazole-induced Torsade de Pointes in a patient receiving methadone substitution therapy

Itraconazole-induced Torsade de Pointes in a patient receiving methadone substitution therapy

Genetic polymorphism and the risk of drug dependence and methadone substitution therapy success

Genetic polymorphism and the risk of drug dependence and methadone substitution therapy success

Gender differences in pharmacokinetics and pharmacodynamics of methadone substitution therapy.

Gender-related differences in the pharmacological effects of drug are an emerging topic. This review examines gender differences in both pharmacokinetic and pharmacodynamic aspects of methadone, a long-acting opioid agonist that is prescribed as a treatment for opioid dependence and the management of chronic pain.Method: We performed a search in the Medline database from 1990 to 2014 in order to find published literature related to gender differences in pharmacokinetics (PK) and pharmacodynamics (PD) of methadone.Results: None of the studies were carried out with the primary or secondary aim to identify any gender differences in the pharmacokinetic profile of methadone. Importantly; high inter-subjects variability in PK parameters was found also intra female population. The reported differences in volume of distribution could be ascribed to the physiological differences between men and women in body weight and composition, taking into account that the dose of methadone was established irrespective of body weight of patients (Peles and Adelson, 2006). On the other hand, the few studies present in literature found no gender difference in some direct pharmacodynamic parameters. Some reports have suggested that female gender is associated with an increased risk for long-QT-related cardiac arrhythmias in methadone maintenance subjects.Conclusion: Even though it may be too simplistic to expect variability only in one parameter to explain inter-individual variation in methadone response, we believe that a better knowledge of gender-related differences might have significant implications for better outcomes in opioid dependence substitution therapy in women.

Public health in a rapidly changing world

Public health in a rapidly changing world

Antiretroviral treatment in adult ethnobotanical intravenous drug users recently infected with HIV

During the last few years in Romania, increased numbers of new HIV infections among ethnobotanicals intravenous drug users (eIVDU) were observed. Although most cases have relatively good immunological status, some patients reclaim antiretroviral (ARV) treatment because of very low CD4 count, severe comorbidities and/or pregnancies despite difficulties related to their adherence. Retrospective analysis of 32 patients, eIVDU, treated with ARV in our hospital between 1st January 2010 and 31st January 2014. From all 32 patients, 27 are males (84.4%). The main reason for starting ARV treatment was represented by severe AIDS-defining illness (71.4%) related to immunodepression with CD4 count below 100 cells/cmm 11 cases (34.3%) and one pregnancy. In our study group the mean CD4 count at baseline was of 110.1 cells/cmm (median CD4 102.5 cells/cmm). 24 patients (75%) received at first triple therapy including NNRTI (10 cases with nevirapine, 14 cases with efavirenz), the other 8 patients (25%) received from the beginning regimens with protease inhibitors. 7 patients from the first group were then switched to protease inhibitors, mostly after completing tuberculostatic treatment, while 2 patients from the second group were switched to integrase inhibitors because of potential drug-drug interactions involving rifampin. All patients in our study were coinfected with HCV, 9 patients (28.9%) had also HBV, and 15 patients (46.8%) had active tuberculosis. Only 15 patients were truly adherent to ARV (43.7%); we registered 5 cases of abandon and one death. From all 5 patients who discontinued treatment 3 were social cases; from all 28 patients who are currently treated 20 have good family support (71.4%) and 6 (21.4%) receive psychological counseling and methadone substitution therapy. Mean value of CD4 count at 1 month of HAART therapy was of 225.8 cells/cmm, probably related to ARV treatment received correctly during admission in our clinic, but this value decreased to 213.3 cells/cmm at 3 months, probably related to poor compliance at home. Despite the fact that they are recently infected with HIV, increasingly more eIVDU patients are in need of ARV treatment, because mainly of rapid immunodepression and comorbidities associated with AIDS. Family support as well as psychological counseling and substitution therapy with methadone are mandatory for achieving clinical success with HAART, while lack of adherence is the principal cause for immunological and virological failure. Tuberculosis with both pulmonary and extrapulmonary involvement is the principal complication associated with AIDS, involving almost half of the eIVDU in our country.

Metadonowa terapia substytucyjna w opinii pacjentów programu metadonowego z województwa łódzkiego – skuteczność, korzyści, problemy

IntroductionAt present the most effective method of opioid addiction treatment is methadone substitution therapy. Its efficacy is dependent on patients’ satisfaction. The aim of this study was to explore the patients’ opinion of the effectiveness of methadone treatment. Respondents also evaluated the incidence of methadone side effects and their influence on daily life. MethodThe survey was conducted at the Substitution Treatment Point at the Specialistic Psychiatric Healthcare Centre in Łódź on opioid-dependent patients enrolled to the methadone programme in March 2013. All patients were asked to fill in an anonymous questionnaire, containing three sections: demographic, drug dependence and therapy and side effects of methadone. ResultsSixty one out of 73 patients completed the questionnaire. Respondents appreciated the benefits of their participation in the methadone programme, however, as many as 54% relapsed during therapy. Ninety three percent felt reduced craving during the therapy. However, among the examined group, total abstinence from other psychoactive substances is a rarity. Patients experienced few methadone side effects which were not obstacles in their daily life. In patients’ opinion, participation in methadone programme helped them return to normal life, though it was often embarrassing. ConclusionsMethadone therapy is an effective method of opioid dependence treatment, which helps maintain abstinence. In terms of side effects, it has proven to be inconsiderably burdensome.

P-08 - Socio-demographic data of the clients in methadone substitution treatment and predictors of developing opiate addiction - a pilot study

From year to year, dependence of opiates is a big problem in society. The number of addicted patients is rapidly growing, also the number of deadly issues of overdose is in growing tendency. Most of the researches showed that among addicted to opiates, are number of people with mental disorders, fragile health, criminal past and unemployed. Methadone substitution treatment is an effective treatment which is harm reduce and is maintaining abstinence from opiates. The sample consisted of 50 patients on methadone substitution therapy in the Methadone center, Sombor. Subjects were tested with inventories which explore trait and state depression and anxiety, and trait of psychopathic deviation. The objectives of the research were: to collect socio-demographic data of patients on methadone substitution therapy. to make a pilot study by which the predictors of becoming addicted can be identified, based on instruments that measure anxiety, depression and psychopathic deviation The instruments: trait anxiety, state anxiety, state depression, trait depression, psychopathic deviation, POMPIDOU. The results confirmed the hypothesis that there is a connection between the first and the regular use of psychoactive substances (PAS). Psychopathic deviation proved to be a significant predictor of becoming dependent - the higher the score on psychopathic deviation scale was, the earlier the patient had become addicted. Hierarchical regression analysis found that PAQ (psychopathic deviation) score explains 18% of the variance of the dependent variable (regular use of PAS). Later borns had significantly higher scores on trait and state depression, compared to the first born.

P-109 - Risk behavior in opioid-dependent individuals after administration therapeutic dose of methadone

Introduction The opioid-addicted subjects increases tend to risk behavior compared to healthy subjects, it is therefore important to indicate whether the administration of methadone reduces this trend. Aims Objective of the study was to assess the propensity for risk behavior in opioid-dependent individuals treated with methadone substitution therapy. Methods The study involved 85 opioid-dependent patients. To assess the tendency to the risk behavior Iowa Gambling Task (IGT) test was used. IGT test was conducted twice: before and about 1 hour after administration of methadone. 132 healthy individuals matched for age and gender were included to the control group and was tested twice at an about 1 hour interval. Results At a similar level was the incidence of risk decisions and safe decisions in the group of addicts before the administration of methadone (49.9 and 50.1) and in the control group (49 and 51). After administration of methadone in a group of addicts and control group incidences of risk and safe decisions were changed. Statistically significant reduction (Wilcoxon matched-pairs signed-ranks, p Conclusions After administration of single dose of methadone there was statistically significantly decreased tendency to risk behavior, which has reduced the incidence of risk decisions compared to the safe decision. The results indicate that in the opioid-dependent individuals treated with methadone substitution therapy a single dose of methadone has an impact on risk behavior as measured by IGT test.

Effectiveness and Cost Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a Mixed HIV Epidemic: A Modeling Analysis for Ukraine

Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine-chosen in this study as a representative country-IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs) receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART). The appropriate resource allocation between these programs has not been studied. We estimated the effectiveness and cost-effectiveness of strategies for expanding methadone substitution therapy programs and ART in mixed HIV epidemics, using Ukraine as a case study. We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs using opiates, and IDUs on methadone substitution therapy, stratified by HIV status, and populated it with data from the Ukraine. We considered interventions expanding methadone substitution therapy, increasing access to ART, or both. We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, infections averted, and incremental cost-effectiveness. Without incremental interventions, HIV prevalence reached 67.2% (IDUs) and 0.88% (non-IDUs) after 20 years. Offering methadone substitution therapy to 25% of IDUs reduced prevalence most effectively (to 53.1% IDUs, 0.80% non-IDUs), and was most cost-effective, averting 4,700 infections and adding 76,000 QALYs compared with no intervention at US$530/QALY gained. Expanding both ART (80% coverage of those eligible for ART according to WHO criteria) and methadone substitution therapy (25% coverage) was the next most cost-effective strategy, adding 105,000 QALYs at US$1,120/QALY gained versus the methadone substitution therapy-only strategy and averting 8,300 infections versus no intervention. Expanding only ART (80% coverage) added 38,000 QALYs at US$2,240/QALY gained versus the methadone substitution therapy-only strategy, and averted 4,080 infections versus no intervention. Offering ART to 80% of non-IDUs eligible for treatment by WHO criteria, but only 10% of IDUs, averted only 1,800 infections versus no intervention and was not cost effective. Methadone substitution therapy is a highly cost-effective option for the growing mixed HIV epidemic in Ukraine. A strategy that expands both methadone substitution therapy and ART to high levels is the most effective intervention, and is very cost effective by WHO criteria. When expanding ART, access to methadone substitution therapy provides additional benefit in infections averted. Our findings are potentially relevant to other settings with mixed HIV epidemics. Please see later in the article for the Editors' Summary.

Monitoring electrocardiograms of service users on high-dose methadone substitution therapy: an audit

Aims and methodTo explore the extent to which 2007 Department of Health guidelines on monitoring of high-dose (⩾100 mg) methadone were followed, the reasons for non-adherence to these and the prevalence of QTc prolongation. We developed a simple tool for collecting data from case notes.ResultsOut of 25 service users, 11 had had an electrocardiogram (ECG) and 7 had evidence of requests sent to general practitioners. After implementation of our recommendations, ten more service users had ECGs within 1 month. All but one ECG was normal. Methadone prescribing in favour of lower doses has been observed. QTc interval prolongation was not common.Clinical implicationsEffective communication between primary and secondary care services is important in identifying cases and arranging ECGs.

Services integration for injection drug users on antiretroviral therapy for management of HIV epidemic in Estonia

Results Estonia had the highest incidence of HIV infection in Europe with 472 cases per million and an adult HIV prevalence of 1,3% in 2007, the second-highest in Europe. Majority of new cases occur in the North-Eastern county, with incidence exceeding 4 times that of Estonia as a whole (183 vs 47 per 100 000). The Estonian epidemic is driven by injection drug use, and local studies have revealed a 40-90% prevalence of HIV among injection drug users (IDUs). HIV treatment is provided by state-funded public health-care system. At end of 2008 1006 patients were receiving HAART. Harm reduction services are provided by non-profit organizations (usually state funded). There are 7 centers for methadone substitution therapy (649 patients treated at end of 2008); 36 syringe exchange programs; 2 centers for free and anonymous STI services. Yet in different regions only 6-28% of IDUs report currently receiving treatment for drug use and 5-12% receiving HAART. The main challenge and strategic goal of the National HIV/AIDS Prevention Strategy remains coverage of IDUs by treatment and harm reduction services. The major barrier identified was failure to provide well integrated services to those in need. The underlying factors leading to the barrier were substantial misperceptions in regards to the utility of methadone substitution therapy among HIV medical care providers.

Predictors of Attrition from a National Sample of Methadone Maintenance Patients

Background: Methadone substitution therapy is an effective harm reduction treatment method for opioid dependent persons. Ability to retain patients in methadone treatment is an accepted predictor of treatment outcomes. Objectives: The current study evaluates the roles of psychiatric comorbidity, medical comorbidity, and sociodemographic characteristics as predictors of retention in methadone treatment utilizing retrospective analysis of data from a nationwide sample of patients in methadone treatment in the VA. Methods: Data were gathered using the VA's national health services use database. A cohort of veterans with a new episode of “opiate substitution” in fiscal year 1999 was identified, and their continuous service use was tracked through fiscal year 2002. The sample included a total of 2,363 patients in 23 VA medical centers. Survival analysis was used to explore factors associated with retention in methadone treatment. Results: Younger age, having a serious mental illness, being African American, or having race recorded as unknown were associated with lower rates of retention in methadone treatment programs in this population of veterans (controlling for site). Conclusion: Given that extended methadone treatment is associated with improved outcomes while patients remain in treatment, more longitudinal studies using primary data collection are needed to fully explore factors related to retention. For the VA population specifically, further research is necessary to fully understand the relationship between race/ethnicity and treatment retention. Scientific Significance: This is the first retention study the authors are aware of that utilizes data from a nationwide, multisite, population of participants in methadone treatment.