title: Why don't out-of-treatment individuals enter methadone treatment programmes?
abstract: BACKGROUND
  Despite the proven effectiveness of methadone treatment, the majority of heroin-dependent individuals are out-of-treatment.
  
  
  METHODS
  Twenty-six opioid-dependent adults who met the criteria for methadone maintenance who were neither seeking methadone treatment at the time of study enrollment, nor had participated in such treatment during the past 12 months, were recruited from the streets of Baltimore, Maryland through targeted sampling. Ethnographic interviews were conducted to ascertain participants' attitudes toward methadone treatment and their reasons for not seeking treatment.
  
  
  RESULTS
  Barriers to treatment entry included: waiting lists, lack of money or health insurance, and requirements to possess a photo identification card. For some participants, beliefs about methadone such as real or rumored side effects, fear of withdrawal from methadone during an incarceration, or disinterest in adhering to the structure of treatment programmes kept them from applying. In addition, other participants were not willing to commit to indefinite "maintenance" but would have accepted shorter time-limited methadone treatment.
  
  
  CONCLUSIONS
  Barriers to treatment entry could be overcome by an infusion of public financial support to expand treatment access, which would reduce or eliminate waiting lists, waive treatment-related fees, and/or provide health insurance coverage for treatment. Treatment programmes could overcome some of the barriers by waiving their photo I.D. requirements, permitting time-limited treatment with the option to extend such treatment upon request, and working with corrections agencies to ensure continued methadone treatment upon incarceration.
authors.affiliation: Friends Research Institute Inc., Social Research Center, Baltimore, MD 21201, USA. jamespeterson4@comcast.net
authors.forename: James A
authors.initials: JA
authors.lastname: Peterson
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Heather Schacht
authors.initials: HS
authors.lastname: Reisinger
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Kelly
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Barry S
authors.initials: BS
authors.lastname: Brown
authors.forename: Michael H
authors.initials: MH
authors.lastname: Agar
mesh_terms: D000328:Adult; D015142:Baltimore; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008019:Life Style / Q000208:ethnology; D008297:Male; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D045808:Refusal to Participate / Q000208:ethnology / Q000523:psychology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000208:ethnology / Q000523:psychology; D055815:Young Adult
chemical_list: D008691:Methadone