Effectiveness of streamlined admissions to methadone treatment: a simplified time-series analysis

Increasing the availability of, and streamlining the admissions process to, methadone treatment have consistently been the focus of national plans to address the acquired immune deficiency syndrome (AIDS) epidemic. This article uses simplified time-series analysis to evaluate one of the first methadone treatment Waiting List Reduction Demonstration Grants. The demonstration grant significantly increased both the number of people requesting intake appointments from 35 to 100 per month and the percentage of kept appointments from 33% to 54%. An additional 100 slots (an entire year's waiting list) were filled in fewer than three months and actually resulted in a net increase in the length of the waiting list. Relative to the preceding two years, new clients during the grant period were significantly more likely to be 41 or older, African-American, unemployed, daily opioid users, daily cocaine users, and dependent on public assistance to finance treatment. Controlling for the source of treatment financing (a case-mix adjustment), there were no significant changes in retention rates. The program's static client capacity rose from 310 prior to the grant to a peak of 449 during the grant, with a leveling to 410 after the grant. Given that it is clearly more humane and less expensive to treat people who want treatment rather than wait for them to commit a crime and be arrested or even executed, this study strongly suggests the need to make more treatment available on demand.