A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification

Abstract

Background: Important questions remain regarding the necessary duration and intensity for methadone treatment to be effective.

Methods: As part of a clinical trial of tuberculosis chemoprophylaxis [Batki, S.L., Gruber, V.A., Bradley, J.M., Bradley, M., Delucchi, K., 2002. A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users. Drug Alcohol Depend. 66 283-293. doi:10.1016/S0376-8716(01)00208-3], patients with opioid dependence were recruited from an outpatient 21-day methadone detoxification program and were randomly assigned to one of three treatment conditions: (1) continuation in 21-day methadone detoxification; (2) transfer to 6-month methadone maintenance with only minimal counseling; or (3) transfer to 6-month methadone maintenance with standard twice monthly counseling and as-needed social work and psychiatric services. Both the 6-month maintenance treatments were followed by 1.5 months of detoxification. Urine drug tests and self-report measures were collected at baseline, months 1-6, and month 8.5.

Results: Compared to 21-day methadone detoxification, 6-month methadone maintenance with either minimal or standard counseling resulted in fewer opiate positive urine tests and days of self-reported heroin and alcohol use. There was no change in cocaine use or other outcome measures. The increased counseling available in the standard counseling condition did not appear to reduce heroin use further than the minimal counseling condition, in contrast to the effect found for more structured counseling in long-term methadone maintenance (McLellan et al., 1993).

Conclusions: Six months of methadone maintenance, even with minimal counseling, reduces heroin and alcohol use more than 21-day methadone detoxification.

Figure 1

Percent urine tests positive for opiates by assessment month and treatment condition. (21-day methadone detoxification, 6-month methadone maintenance with minimal counseling, 6-month methadone maintenance with standard counseling.) Although the standard errors of some of the proportions may overlap [SEP = p (1-p)/n], the combined difference was statistically significant: Opiate positive urine tests months 1–6: Minimal MM vs. Detox p = .0302. Opiate positive urine tests months 1–8.5: Minimal MM vs. Detox p = .0149.