Question 4: Does methadone maintenance treatment reduce criminal activity?

Answer: Yes. Patients are less likely to become involved in criminal activity while in methadone maintenance treatment.

• Patients who remain in methadone maintenance treatment for long periods of time are less likely to be involved in criminal activity than patients in treatment for short periods.
• The availability of methadone maintenance treatment in a community is associated with a decrease in that community’s criminal activity, particularly theft.

Research Highlights

• In a meta-analysis of 24 studies, results indicate an overall small-to-medium effect of r = -0.25 (unweighted) of the impact of methadone maintenance on criminal activity. A large effect size of r = 0.70 (unweighted) was seen in those studies that investigated the efficacy of methadone maintenance treatment in reducing drug-related criminal behaviors. A small-to-moderate effect of r = 0.23 (unweighted) was obtained when both drug and property-related criminal activities were evaluated. Finally, a small effect of r = 0.17 (unweighted) was demonstrated when drug- and nondrug-related criminal behaviors were combined (Marsch, 1998).
• In the Treatment Outcome Perspective Study (TOPS), 32 percent of the methadone maintenance patients acknowledged committing one or more predatory crimes in the year before treatment, but only 10 percent continued these activities during treatment. By 3 to 5 years after leaving treatment, only 16 percent of the patients reported predatory criminal activity–a reduction of one-half the pretreatment level (Hubbard, Marsden, Rachal, et al., 1989).
• Among the 617 patients studied by Ball and Ross (1991), there was a 70.8-percent decline in crime-days within the 4-month methadone maintenance treatment period. This decline was followed by continuing, but less dramatic, declines in mean crime-days among those in treatment for 1 to 3 years. Those in treatment for 6 or more years had the lowest rate of crime-days per year (14.5).
• The Powers and Anglin (1993) retrospective study of 933 heroin addicts demonstrated that rates of criminality, arrests, and drug dealing decreased during episodes of methadone maintenance treatment when compared with addicts not in treatment.
• In the National Treatment Outcome Research Study, acquisitive criminal behavior decreased in the majority of the 333 patients except those (n = 88) who were felt to have a poor treatment response. In these patients, there was no change in this type of criminal activity (Gossop, Marsden, Stewart, et al., 2000).
• The meta-analysis by Mattick, Breen, Kimber, et al. (2003) revealed that criminal activity declined in consort with reductions in heroin use, although the advantage for methadone beyond control in reducing criminal activity was not statistically significant (3 studies, 363 patients: RR = 0.39, 95% CI: 0.12-1.25).

The Effects of Methadone Maintenance Treatment on Crime-Days–Ball and Ross study (1991) of 617 patients demonstrated that methadone maintenance treatment is associated with a dramatic decline in the average number of crime-days per year.

Figure 17 illustrates that the average number of crime-days per year before treatment was 237. During the 4-month initial methadone maintenance treatment, the average number of crime-days per year was 69. This represents about a 71-percent decline. This dramatic decline was followed by continuing, but less dramatic, declines in the average number of crime-days among those in methadone maintenance treatment for 1 to 3 years. Patients who remained in methadone maintenance treatment for 6 or more years reported only 14.5 crime-days per year, representing a 94-percent decline in average number of crime-days (Ball and Ross, 1991).

Crime Before and During Methadone Maintenance Treatment at Six Programs-Ball and Ross (1991) found a dramatic decline in crime when comparing pretreatment crime-days per year and the number of crime-days per year after 6 months or more in methadone maintenance treatment.

Figure 18 illustrates the average number of crime-days reported by patients in six methadone maintenance treatment programs. Although there are differences among programs, the dramatic decrease in crime-days before and during methadone maintenance treatment occurs for all six programs. Crime was reduced by approximately 90 percent in program A, 95 percent in program B, 93 percent in program C, 87 percent in program D, 92 percent in program E, and 90 percent in program F. The average reduction in crime for those in methadone maintenance treatment was just over 91 percent (Ball and Ross, 1991).

The cost benefits of methadone maintenance treatment become obvious when one compares the costs of providing treatment with the social costs that would have occurred if the crime level had continued.

References

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

Gossop M, Marsden J, Stewart D, Rolfe A. Patterns of improvement after methadone treatment: 1 year follow-up results from the National Treatment Outcome Research Study. Drug & Alcohol Dependence 2000;60(3):275-86.

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.

Marsch LA. The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction 1998;93(4):515-32.

Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane Database of Systematic Reviews, Issue 2, 2003.

Powers KI, Anglin MD. Cumulative versus stabilizing effects of methadone maintenance. Evaluation Review1993;17(3):243-70