Merits and problems in high-threshold methadone maintenance treatment. Evaluation of medication-assisted rehabilitation in Norway 1998-2004.
BACKGROUND
Methadone maintenance treatment (MMT) in Norway emphasizes rehabilitation and control with strict intake criteria and rules for involuntary termination. Consequently, the programme should be characterized as high threshold and restrictive, which is somewhat out of tune with the general European trend towards harm reduction and diversity.


METHODS
The programme has undergone an extensive evaluation with quantitative and qualitative methods.


RESULTS
MMT is at present integrated into the general health and social security system. The restrictive traits have not prevented rapid development in the capacity and coverage. Results on retention and drug use are above average for MMT programmes, but results on vocational rehabilitation are not impressive. The system is costly and some inherent structural problems cause concern.


CONCLUSIONS
On this basis, central authorities have decided to keep the core structure of the programme, but to implement several changes. Medical diagnosis and evaluation should replace formal regulating criteria.
Waal
Helge
H
Unit for Addiction Medicine, Institute of Psychiatry, University of Oslo, Oslo, Norway. helge.waal@medisin.uio.no
D000328:Adult; D003710:Demography; D004651:Employment; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009664:Norway / Q000453:epidemiology; D018579:Patient Selection; D010415:Pensions; D018401:Sample Size; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome
D008691:Methadone