Impact of methadone program philosophy changes on early treatment outcomes.
This paper describes the consequences of changing from methadone maintenance treatment focussed primarily on elimination of all illicit drug use and social reintegration to patient-centred care. Counselling (formerly mandatory) became optional, patients were retained in treatment despite continued illicit drug use, the ceiling on methadone doses was removed, patient input became a part of methadone prescribing and the number of patients in treatment more than doubled. Across three cohorts (before, during and after the program was redesigned) the mean daily dose of methadone increased (50.4 mg +/- 2.5, 72.6 mg +/- 2.4, 92.2 mg +/- 4.0, respectively). The number of physician visits increased linearly with cohort while the number of therapist visits was unchanged overall. Two-year treatment retention was not significantly different (73%, 69% and 67%, respectively). In all three cohorts there was a significant reduction in opioid and benzodiazepine use but not cocaine use over the first six months of treatment.
Brands
Bruna
B
Centre for Addiction and Mental Health, Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada. bruna_brands@camh.net
Blake
Joan
J
Marsh
David
D
D000328:Adult; D002985:Clinical Protocols; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D007223:Infant; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects; D009864:Ontario; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D018802:Patient-Centered Care; D010686:Philosophy, Medical; D011247:Pregnancy; D015397:Program Evaluation / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D014600:Utilization Review
D013287:Illicit Drugs; D009294:Narcotics; D008691:Methadone