Patient-centered methadone treatment: a randomized clinical trial.
Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual.



Two-arm open-label randomized trial.



Two methadone treatment programs (MTPs) in Baltimore, MD, USA.



Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males.



Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151).



The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment.



There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05).



Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.
Friends Research Institute, Baltimore, MD, USA.
Robert P
RP
Schwartz
Friends Research Institute, Baltimore, MD, USA.
Sharon M
SM
Kelly
Friends Research Institute, Baltimore, MD, USA.
Shannon G
SG
Mitchell
Friends Research Institute, Baltimore, MD, USA.
Jan
J
Gryczynski
Department of Psychology, University of Maryland, College Park, MD, USA.
Kevin E
KE
O'Grady
University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD, USA.
Devang
D
Gandhi
Institute for Behavioral Resources, REACH, Baltimore, MD, USA.
Yngvild
Y
Olsen
Friends Research Institute, Baltimore, MD, USA.|University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD, USA.
Jerome H
JH
Jaffe
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D018802:Patient-Centered Care / Q000379:methods*; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone
Methadone treatment; opioid substitution therapy; opioid use disorder; patient-centered care; therapeutic alliance; treatment retention
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