Detected heroin use in an Australian methadone maintenance program

Area of Science:

• Addiction medicine
• Public health
• Clinical psychology

Background:

• Methadone maintenance therapy (MMT) is a cornerstone of opioid use disorder treatment.
• Abstinence-oriented programs aim to eliminate illicit substance use among patients.
• Effectiveness of disciplinary measures in MMT requires ongoing evaluation.

Purpose of the Study:

• To reanalyze survey and urinalysis data from an abstinence-oriented MMT program in Sydney.
• To assess the impact of the program's disciplinary approach on detected heroin use.
• To identify patient characteristics associated with continued heroin use during MMT.

Main Methods:

• Retrospective analysis of patient survey and urinalysis data.
• Logistic regression modeling to identify predictors of positive morphine results.
• Comparison of findings with previous Australian methadone program reports.

Main Results:

• The program's disciplinary measures did not significantly reduce detected heroin use (27% morphine-positive urines).
• Higher likelihood of positive urines in women, those with a partner in MMT, and ex-prisoners.
• Psychologically disturbed patients were less likely to submit positive urines, suggesting higher attrition from treatment.

Conclusions:

• The abstinence-oriented MMT program's disciplinary approach was ineffective in reducing heroin use.
• Patient demographics and psychological status influence treatment retention among heroin users.
• Psychological disturbance may be a factor in the differential dropout rates of heroin-using MMT patients.