title: Evidence-based treatment for opioid disorders: a 23-year national study of methadone dose levels.
abstract: Effective treatment for patients with opioid use problems is as critical as ever given the upsurge in heroin and prescription opioid abuse. Yet, results from prior studies show that the majority of methadone maintenance treatment (MMT) programs in the US have not provided dose levels that meet evidence-based standards. Thus, this paper examines the extent to which US MMT programs have made changes in the past 23 years to provide adequate methadone doses; we also identify factors associated with variation in program performance. Program directors and clinical supervisors of nationally-representative methadone treatment programs were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), 2005 (n=146), and 2011 (n=140). Results show that the proportion of patients who received doses below 60 mg/day-the minimum recommended-declined from 79.5 to 22.8% in a 23-year span. Results from random effects models show that programs that serve a higher proportion of African-American or Hispanic patients were more likely to report low-dose care. Programs with Joint Commission accreditation were more likely to provide higher doses, as were a program that serves a higher proportion of unemployed and older patients. Efforts to improve methadone treatment practices have made substantial progress, but 23% of patients across the nation are still receiving doses that are too low to be effective.
authors.affiliation: Columbia University, 600W. 168th St., #403, New York, New York 10032. Electronic address: tdaunno@columbia.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Aunno
authors.affiliation: University of Chicago, School of Social Administration, 969 E. 60th Street, Chicago, IL 60637. Electronic address: haroldp@uchicago.edu.
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pollack
authors.affiliation: Mailman School of Public Health, Columbia University, 600W. 168th St., #604, New York, New York 10032. Electronic address: jf2584@cumc.columbia.edu.
authors.forename: Jemima A
authors.initials: JA
authors.lastname: Frimpong
authors.affiliation: Mailman School of Public Health, Columbia University, 600W. 168th St., New York, New York 10032. Electronic address: dmw2154@columbia.edu.
authors.forename: David
authors.initials: D
authors.lastname: Wutchiett
mesh_terms: D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D008137:Longitudinal Studies; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
chemical_list: D008691:Methadone
keywords: Dose levels; Methadone; Opioid disorders; Organizational correlates