Question 16: What are the retention rates for methadone maintenance treatment?

Answer: Retention in methadone is related to the dose of methadone but not the provision of ancillary services.

Research Highlights

• A meta-analysis of studies comparing the provision of methadone maintenance with and without ancillary services demonstrated decreased illicit heroin use with ancillary services but found no statistically significant additional benefit in terms of retention in treatment, RR 0.94 (95% CI, 0.85 to 1.02) (Amato, Davoli, Perucci, et al., 2005).
• An observational study of 351 patients in the United Kingdom receiving methadone maintenance compared with those receiving methadone dose reduction found the following retention rates: 88 percent vs. 86 percent at 1 month, 71 percent vs. 58 percent at 2 months, 62 percent vs. 50 percent at 1 year, and 42 percent vs. 30 percent at 2 years (Gossop, Marsden, Stewart, et al., 2001).
• An Italian study followed 1,503 heroin-dependent patients who received treatment in the form of methadone maintenance, a drug-free program, or naltrexone. The retention rate after 1 year was 40 percent for patients in methadone maintenance, 18 percent in naltrexone, and 15 percent in the drug-free program. Patients receiving methadone greater than or equal to 60 mg per day and 30 to 59 mg per day were respectively 70 and 50 percent more likely to remain in treatment than those receiving less than 30 mg per day. Patients receiving methadone maintenance were 30 percent more likely to remain in treatment than those not receiving methadone (D'Ippoliti, Davoli, Perucci, et al., 1998).
• Thirty-eight percent of the new patient group (total 126) in the Ball and Ross (1991) studies of six methadone maintenance treatment programs remained in treatment after a year; 63 percent of the moderate-stay group (total 345) were still in treatment a year later; and 84 percent of the long-term patients (total 146) continued their methadone maintenance treatment for another year.
• In a study of 311 admissions to three methadone maintenance treatment programs during 1990 and 1991, 24 percent dropped out within 60 days. The significant predictors of retention were social stability (being married, employed, and having few prior arrests); previous treatment experience; high dosage levels; and motivation for treatment (Simpson and Joe, 1993).

Additional Studies

• In a study of 351 daily or weekly heroin users who were admitted to 1 of 17 publicly funded methadone treatment programs, predictors of retention in methadone maintenance treatment programs included (1) positive patient evaluations of the quality of social services received during the first month after admission (e.g., family, legal, educational, employment, financial services); (2) positive patient ratings of how easily accessible the program was; and (3) participation in programs that informed patients of their methadone dosage levels (Condelli, 1993).

Figure 32 illustrates 1-year treatment retention rates for three large studies.

Figure 33 illustrates that in the Treatment Outcome Perspective Study (TOPS), patient self-report ratings of the quality (not the number) of social services received during the first month of methadone maintenance treatment were a strong predictor of retention (Condelli and Dunteman, 1993). The study suggests that methadone maintenance treatment programs should provide patients with high-quality social services as soon as possible after admission in order to promote retention. The study found that three program and two patient variables predicted retention. It also noted that patients who were 25 years of age or younger were more likely than older patients to drop out of methadone maintenance treatment programs, possibly because they lacked the motivation, maturity, and life goals that often characterize older patients.

Likelihood of Relapse After Leaving Methadone Treatment–Of 105 patients who were followed in the community after leaving methadone maintenance treatment after 1 month to 1 year or longer, two-thirds (67.6 percent) relapsed to injection drug use (Ball and Ross, 1991).

References

Amato L, Davoli M, Perucci C, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment 2005;28(4):321-29.

Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York: Springer-Verlag, 1991.

Condelli WS. Strategies for increasing retention in methadone programs. Journal of Psychoactive Drugs1993;25(2):143-47.

Condelli WS, Dunteman GH. Exposure to methadone programs and heroin use. American Journal of Drug and Alcohol Abuse 1993;19:65-78.

D'Ippoliti D, Davoli M, Perucci CA, Pasqualini F, Bargagli AM. Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage. Drug & Alcohol Dependence 1998;52(2):167-71.

Faggiano F, Vigna-Taglianti F, Versino E, Lemma P. Methadone maintenance at different dosages for opioid dependence. The Cochrane Database of Systematic Reviews, Issue 3, 2003.

Gossop M, Marsden J, Stewart D, Treacy S. Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug & Alcohol Dependence 2001;62(3):255-64.

Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM. Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill: University of North Carolina Press, 1989.

Sells SB, Simpson DD (eds.). The Effectiveness of Drug Abuse Treatment. Cambridge, MA: Ballinger, 1976.

Simpson DD, Joe GW. Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy1993;30(2):357-68