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Randomized Controlled Trial
. 2017 Mar;112(3):454-464.
doi: 10.1111/add.13622. Epub 2016 Nov 10.

Patient-centered methadone treatment: a randomized clinical trial

Robert P Schwartz  1 , Sharon M Kelly  1 , Shannon G Mitchell  1 , Jan Gryczynski  1 , Kevin E O'Grady  2 , Devang Gandhi  3 , Yngvild Olsen  4 , Jerome H Jaffe  1   3
Affiliations
Randomized Controlled Trial

Patient-centered methadone treatment: a randomized clinical trial

Robert P Schwartz et al. Addiction. 2017 Mar.

Abstract

Background and aims: 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.

Design: Two-arm open-label randomized trial.

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

Participants: 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.

Intervention: 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).

Measurements: 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.

Findings: 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).

Conclusions: 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.

Keywords: Methadone treatment; opioid substitution therapy; opioid use disorder; patient-centered care; therapeutic alliance; treatment retention.

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Conflict of interest statement

Declarations of interest No financial disclosures were reported by the other authors.

Figures

Figure 1
Figure 1. CONSORT Diagram
*Reasons for not meeting inclusion criteria are as follows: transferred from another methadone treatment program (n=5); pregnant (n=4); not a new admission (n=1); unable to pass consent quiz (n=3); unable to complete baseline interview (n=1); no recent heroin use (n=5); re-admitted to program but already in study (n=2).
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