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Methadone "callbacks" within a veterans affairs opioid treatment program: Detecting methadone misuse
Ann J Cotton1,2, Leandra J Shipley1,3, Lisa H Glynn1,3
1U.S. Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
The American Journal on Addictions
|December 23, 2016
Summary
For-cause callbacks are more effective than random checks for detecting methadone misuse in opioid treatment programs. Clinical judgment in for-cause callbacks identifies patients who fail inspections, indicating potential misuse.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- "Callback" procedures in opioid treatment programs (OTPs) require patients to present take-home methadone doses for inspection.
- A quality improvement project was conducted to compare the efficacy of random versus "for-cause" callbacks.
Purpose of the Study:
- To evaluate the effectiveness of random callbacks versus "for-cause" callbacks in identifying methadone misuse.
- To determine which callback strategy is more beneficial in an OTP setting.
Main Methods:
- The study involved 183 patients in an OTP.
- Eighty-two random callbacks and 60 "for-cause" callbacks were performed.
- Callback outcomes were analyzed based on the number of take-home doses and callback type.
Main Results:
- For patients with more take-home doses, 6% of random callbacks failed compared to 44% of "for-cause" callbacks.
- For patients with fewer take-home doses, 36% of "for-cause" callbacks failed.
- "For-cause" callbacks demonstrated a higher failure rate, particularly among patients with more take-home doses.
Conclusions:
- "For-cause" callbacks, guided by clinical judgment, are more effective than random callbacks in detecting methadone misuse.
- This strategy enhances the quality of care and safety within OTPs.
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