Answers: Methadone Research Web Guide

Meta-analyses conducted by researchers such as Mattick, Breen, Kimber, et al. (2003) and Marsch (1998) have demonstrated across countries and populations that methadone can be effective in improving treatment retention, criminal activity, and heroin use.

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The impact of methadone dose has been demonstrated consistently across studies and countries. Doses larger than 50 mg of methadone are associated with better treatment retention and decreased illicit drug use (Strain, Stitzer, Liebson, et al., 1993; Strain, Bigelow, Liebson, et al., 1999; Capelhorn and Bell, 1991; Capelhorn, Bell, Kleinbaum, et al., 1993; Faggiano, Vigna-Taglianti, Versino, et al., 2003).

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Ball and Ross (1991) demonstrated that methadone maintenance treatment is associated with a dramatic decline in the average number of crime-days per year: a 71-percent decline after 4 months and a 94-percent decline for patients who remained in methadone maintenance treatment for 6 or more years.

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The medication methadone has no direct effect and is not intended to have an effect on rates of alcohol and other drug use. When methadone treatment programs also include services specifically designed to reduce alcohol and other drug use, however, patients are likely to report decreases in such use.

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Although methadone maintenance patients can experience side effects in the early stages of treatment, Kreek (1979), Jaffe and Martin (1985), and Hartel (1989/1990) have shown that many of these side effects disappear with adequate methadone treatment.

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Research has demonstrated that methadone maintenance treatment is cost-effective and pays for itself in basic economic terms. In 1991, NIDA researchers estimated that the yearly cost to maintain an opioid addict in New York was $43,000 for addicts untreated and on the street; $34,000 for prisoners; $11,000 for individuals in a residential drug-free program; and $2,400 for methadone maintenance treatment patients.

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Improved treatment outcomes in patients receiving methadone maintenance are associated with the availability of a variety of psychosocial services for those who require them.

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Although the specific dosage for a patient cannot be determined arbitrarily because patients metabolize methadone at different rates, research regarding methadone dosage levels clearly establishes that low doses of methadone are less effective.

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Several studies have noted that, overall, patients who demonstrate emotional, psychological, and social well-being generally experience greater treatment success than patients who have emotional, psychological, and social problems. (McLellan, 1983; Simpson and Sells, 1982; Ball and Ross, 1991; Anglin and Hser, 1990).

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An Italian study (D'Ippoliti, Davoli, Perucci, et al., 1998) found that patients receiving methadone maintenance were 30 percent more likely to remain in treatment than those not receiving methadone.

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Patients who are legally coerced into methadone maintenance treatment experience treatment success at about the same rate as patients who participate voluntarily in treatment.

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Although methadone maintenance treatment has been shown to result in a rapid decline in illicit opioid use that can remain steady for years, Ball and Ross (1991) found that 82 percent of patients who discontinued methadone relapsed to intravenous drug use within 12 months. Thus, maintenance treatment is recommended as long as the patient continues to benefit and suffers no significant side effects.

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Although many researchers (Sullivan, Metzger, Fudala, et al., 2005; Gowing, Farrell, Bornemann, et al., J Gen Intern Med. 2006 Feb;21(2):193-5.) have demonstrated that methadone maintenance treatment decreases injection drug use, thus helping to reduce HIV infection transmitted through unsafe injection practices, researchers have also documented that methadone treatment had little or no effect on reducing sexual risk behaviors, such as the use of condoms (Gowing, Farrell, Bornemann, et al., 2004)

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Additional psychosocial support services are needed to maximize the effectiveness of methadone maintenance treatment. McLellan, Arndt, Metzger, et al. (1993) reported that outcomes were significantly better in groups of injection drug users that also received psychosocial services.

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Researchers have found a consistent, statistically significant relationship between methadone maintenance treatment and the reduction of HIV risk behaviors. Serpelloni, Carrieri, Rezza, et al. (1994) found that the length of time that injection drug users stayed in methadone maintenance treatment was a major determinant in their remaining HIV-free.

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Gender-specific issues, which are often related to the social status of women, are important to treatment effectiveness for female injection drug users.

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Research has documented that methadone maintenance treatment reduces adverse pregnancy and birth outcomes. Although infants exposed to methadone may experience withdrawal, the abstinence syndrome is treatable and methadone is not associated with any long-term neurobehavioral consequences.

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Kreek and colleagues have demonstrated that pregnancy can reduce methadone blood levels, causing withdrawal and placing women at risk of relapse to drug use. It is important to determine the relapse risk for each woman when considering a dosage change because a woman steadily maintained on methadone is more likely to have a healthy pregnancy and infant than a woman who uses alcohol and other drugs.

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Like methadone, the correct dose of buprenorphine has the ability to suppress opioid craving and withdrawal, block the effects of self-administered opioids, retain patients in treatment, and decrease illicit opioid use.

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Although both methadone and buprenorphine can be diverted from their intended recipients, most studies note that the benefits of providing the treatment outweigh the risks associated with side-effects or diversion.

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