Dosage patterns in methadone treatment: results from a national survey, 1988-2005.
OBJECTIVE
To examine the extent to which U.S. methadone maintenance facilities meet established standards for minimum dosages, 1988-2005.


METHODS
Data were collected from a nationally representative sample of outpatient treatment facilities in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), and 2005 (n=146).


METHODS
Random-effects multiple regression analysis was used to examine unit characteristics associated with below recommended doses.


METHODS
Data regarding the proportion of patients who received maintenance dosages of <40, 60, and 80 mg/day were collected from unit directors and clinical supervisors.


RESULTS
Forty-four percent of patients receive doses of at least 80 mg/day--the threshold identified as recommended practice in recent work. Thirty-four percent of patients receive doses below 60 mg/day, while 17 percent receive doses below 40 mg/day. Units that serve a high proportion of African American or Latino clients were more likely to report low-dose care. Units managed by individuals who strongly favor abstinence models (e.g., Narcotics Anonymous) were more likely to provide low-dose care.


CONCLUSIONS
One-third of methadone facilities provide doses below recommended levels. Managerial attitudes about abstinence and their relationship to low doses underscore the contested role of methadone in treatment of opiate disorders.
Center for Health Administration Studies, University of Chicago, 969 East 60th St., Chicago, IL 60637, USA. haroldp@uchicago.edu
Harold A
HA
Pollack
Thomas
T
D'Aunno
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D019538:Health Care Surveys; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs; D008691:Methadone / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D015203:Reproducibility of Results
D000701:Analgesics, Opioid; D008691:Methadone