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Leaving methadone treatment: lessons learned, lessons forgotten, lessons ignored
1National Development and Research Institutes, Inc., Two World Trade Center, 16th floor, New York, NY 10048, USA.
The Mount Sinai Journal of Medicine, New York
|January 3, 2001
Summary
Discontinuing methadone maintenance treatment often leads to high relapse rates and increased mortality for opioid users. Long-term opioid replacement therapy should not be discouraged due to poor post-treatment outcomes.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- Methadone maintenance therapy (MMT) offers benefits but faces ethical and financial concerns regarding long-term use.
- Patient psychosocial functioning and societal preference for abstinence fuel interest in time-limited methadone treatment.
- Research is needed to understand outcomes after various methadone treatment durations.
Purpose of the Study:
- To review and synthesize published research on post-discharge outcomes for patients exiting different types of methadone treatment.
- To evaluate the effectiveness of extended methadone detoxification, abstinence-oriented programs, and regular MMT.
Main Methods:
- Systematic review of published research literature.
- Analysis of studies examining patient outcomes after discontinuation of methadone treatment.
- Comparison of relapse rates and mortality across different treatment exit strategies.
Main Results:
- Virtually all studies report high rates of relapse to opioid use after methadone treatment cessation.
- High relapse rates persist even for patients completing detoxification programs.
- Significant increases in mortality rates were observed following discharge from methadone treatment.
Conclusions:
- Current evidence strongly indicates high relapse and mortality risks associated with discontinuing methadone treatment.
- Treatment providers and policymakers should exercise caution regarding policies that limit or discourage long-term MMT.
- Further research is crucial to identify strategies for improving outcomes after methadone detoxification.
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