Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study
Abstract
This paper provides a detailed analysis of the 2-year outcomes for 351 drug misusers allocated on an intention-to-treat basis to methadone maintenance or methadone reduction treatments. Both groups showed substantial reductions in their use of illicit drugs and in other outcome areas. However, whereas most methadone maintenance patients received maintenance, only about one third of those allocated to methadone reduction received methadone reduction, and many actually received a form of methadone maintenance. Reduction patients were more likely to receive low doses of methadone, and were less likely to remain in treatment. For maintenance patients, higher doses and retention in treatment were both associated with improvements in illicit heroin use at 2 years. For the reduction patients, the more rapidly the methadone was reduced, the worse the heroin use outcomes. For patients in both treatment conditions, reductions in heroin use were associated with improvements in other outcome areas. The more severely dependent patients showed better outcomes in methadone maintenance. Methadone reduction treatment processes were associated with poor outcomes, and many patients who were allocated to methadone reduction treatment did not receive reduction treatment as intended. This calls into question the appropriateness of either the initial treatment planning process or the treatment delivery process, or both. A clearer distinction should be made between methadone maintenance and methadone reduction. Treatment goals should be made explicit both to the patient and to the clinical staff at the start of treatment. We suggest the need for a reappraisal of the goals and procedures of methadone reduction treatment.
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Maintenance therapy enables clients to manage withdrawal effects and reduces craving by providing a substitute.
“Maintenance therapy enables clients to manage withdrawal effects and reduces craving by providing a substitute and is empirically supported (Gossop et al., 2001).”
From “I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design) (2023) · cites this paper as Gossop et al., 2001
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- Authors
- Gossop, M., Marsden, J., Stewart, D., & Treacy, S.
- Corresponding author
- Gossop, Michael
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2001-05-01
- Volume
- 62
- Issue
- 3
- Pages
- 255-264
- ISSN
- 0376-8716 (ISSN-L)
- OpenAlex
- W2003855549
- Cited by
- 175
- References
- 36
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 11 · 2015: 8 · 2014: 10 · 2013: 6 · 2012: 9
- FWCI
- 10.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- University of Pennsylvania
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- methadone maintenance treatment, opioid use disorder, heroin use, treatment retention, treatment dose, treatment planning, drug abuse, treatment outcomes
- MeSH terms
- Follow-Up Studies, Heroin Dependence, Humans, Methadone, Narcotics, Chi-Square Distribution, Logistic Models, Substance Abuse Treatment Centers, Treatment Outcome, Substance-Related Disorders
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