Are 2 weeks of "take-home" privileges beneficial for patients' long-term outcome in a methadone maintenance treatment program?
OBJECTIVE
Patients in Israeli methadone maintenance treatment can achieve a maximum of 2 weeks of take-home dose (13-THD) privileges after at least 2 years since the achievement of 1-week privileges (6-THD). Patients who ever achieved 6-THD were characterized to predict achievement of 13-THD.


METHODS
All patients who ever achieved 6-THD and then achieved 13-THD were studied (December 2010-December 2012). Information on drugs in urine on admission, demographics, and addiction characteristics was retrieved from medical charts. Retention in treatment and duration with THD were calculated and analyzed by Kaplan-Meier and Cox model regression.


RESULTS
Fifty-five of the 161 patients who achieved 6-THD also achieved 13-THD. No benzodiazepine abuse on admission (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.1-4.7), being Israeli-born (OR = 2.3, 95% CI: 1.1-5.2), and less than 12 years of education (OR = 2.8, 95% CI: 1.1-7.1) predicted the 13-THD achievers. The time to achieve 6-THD was shorter for the 13-THD patients than for the 106 who achieved only 6-THD (1.7 ± 1.5 vs. 2.3 ± 2.0 years, P = 0.07). After losing THD privileges, the 13-THD group showed a worse outcome than the 6-THD group: 1 year after losing 6-THD (n = 92) or 13-THD (n = 27), 3.3% of the former left treatment versus 14.8% of the latter, whereas 83.7% versus 70.4%, respectively, succeeded in regaining any THD and 12.0% versus 14.8%, respectively, failed altogether.


CONCLUSIONS
Patients who achieved 13-THD were characterized by more rapid progress in rehabilitation, but those who failed and lost 13-THD privileges were at a higher risk to deteriorate further than those who failed after achieving 6-THD.
The first 2 authors (M.A. and S.S.) contributed equally. From the Adelson Clinic for Drug Abuse, Treatment & Research (MA, SS, AS, EP), and Department of Psychiatry (SS, EP), Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
Miriam
M
Adelson
Shaul
S
Schreiber
Anat
A
Sason
Einat
E
Peles
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D012646:Self Administration / Q000379:methods; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone