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A multicenter randomized evaluation of methadone medical maintenance
Van L King1, Kenneth B Stoller, Michael Hayes
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Behavioral Biology Research Center, 5510 Nathan Shock Drive, Ste. 1500, Baltimore, MD 21224, USA. kingvl@jhmi.edu
Drug and Alcohol Dependence
|January 5, 2002
Summary
Methadone medical maintenance (MMM) offers a cost-effective treatment matching service intensity to patient needs. This approach demonstrated high patient satisfaction and improved social engagement without compromising treatment integrity.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- Methadone maintenance treatment (MMT) is a cornerstone for opioid use disorder.
- Optimizing MMT delivery models is crucial for cost-effectiveness and patient outcomes.
- Current MMT often involves frequent clinic visits, potentially limiting patient engagement in other life domains.
Purpose of the Study:
- To evaluate the efficacy and patient satisfaction of Methadone Medical Maintenance (MMM) compared to routine MMT.
- To assess the safety and feasibility of a stepped care approach within MMM.
- To determine if reduced reporting frequency in MMM impacts treatment adherence and illicit drug use.
Main Methods:
- A randomized trial involving 73 stable MMT patients.
- Comparison of routine MMT versus MMM with monthly reporting (clinic-based or physician office).
- Implementation of a 'stepped care' model for patients with non-adherence indicators (e.g., positive urine, failed recall).
Main Results:
- Low rates of illicit drug use (1% of specimens) and no evidence of methadone diversion.
- MMM patients showed increased initiation of employment and social/family activities.
- High patient satisfaction reported across all groups, with MMM patients expressing greater satisfaction.
Conclusions:
- Methadone Medical Maintenance (MMM) is a safe, effective, and patient-centered MMT delivery model.
- The stepped care approach effectively matched treatment intensity to patient needs.
- MMM can be successfully integrated into both clinic and office-based settings as part of a continuum of care.