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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 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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ResultQuality of Life of Outpatients in Methadone Maintenance Treatment Clinics
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“These findings were fairly expected and are consistent with the results of cohorts (Gossop et al., 2001; Simpson et al., 1997a), randomized controlled trials (Johnson, Jaffe, and Fudala, 1992; Johnson et al., 2000; Strain, Bigelow, Liebson, and Stitzer, 1999), and systematic reviews (Faggiano,…”
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ResultPatient-centered methadone treatment: a randomized clinical trial
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“Retention in the program is consistent with retention estimates from other programs throughout Europe [24, 25], Asia [26, 27], and North America [28–30].”
ResultSex differences in factors predicting post‐treatment opioid use
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“…to the overall retention rate reported in a metaanalysis of MMT treatment retention (Bao et al., 2009), though it compares unfavorably with retention rates reported in Israel (Peles et al., 2006), England (Gossop et al., 2001), and in certain settings in the United States (Farré et al., 2002).”
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Self-citationPredictors of methadone program non-retention for opioid analgesic dependent patients
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Alexander, J. A., Nahra, T. A., Lemak, C. H., Pollack, H. A., & Campbell, C. I. (2007) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2007.04.009 · Cited by 24
Changes in mental health during opiate replacement therapy: A systematic review
Fingleton, N. A., Matheson, C., & Jaffray, M. (2014) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2014.899986 · Cited by 23
“This change was maintained at year 2, but with no further significant improvements (Gossop et al., 2001, 2002).”
BackgroundMethodGjersing, L., Waal, H., Caplehorn, J. R. M., Gossop, M., & Clausen, T. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-194 · Cited by 23
“Treatment objectives range from harm reduction [8], long-term maintenance and rehabilitation [2], to abstinence from all drugs including treatment medication [ 9 ].”
Self-citationComparison of Buprenorphine and Methadone in the Treatment of Opiate Withdrawal
Reed, L. J., Glasper, A., de Wet, C., Bearn, J., & Gossop, M. (2007) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e318032ec2a · Cited by 23
“The use of buprenorphine detoxification with patients dependent upon methadone doses of up to 70 mg, as in the present study, has direct relevance to clinical practice because few patients receive methadone doses of 30 mg or less.(16,17) The present results are consistent with findings from other studies that have fou…”
ResultSelf-citationMethadone treatments in a Swiss Region, 2001–2008: a registry-based analysis
Huissoud, T., Rousson, V., & Dubois-Arber, F. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-238 · Cited by 22
“The long treatment durations associated with high rates of re-entry after interruption observed in our study contribute additional thoughts to the debate regarding the real possibilities of methadone withdrawal in OSTM.”
BackgroundResultInfluentialConcurrent drug injection during opioid agonist treatment among people who inject drugs in Ukraine
Makarenko, I., Mazhnaya, A., Marcus, R., Pykalo, I., Madden, L. M., Filippovich, S., Дворяк, С., & Altice, F. L. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.01.007 · Cited by 21
Jackson, L. A., Buxton, J. A., Dingwell, J., Dykeman, M. C., Gahagan, J., Gallant, K. A., Karabanow, J., Kirkland, S., LeVangie, D., SKETRIS, I. S., et al. (2014) · BMC Psychology · doi:10.1186/s40359-014-0026-3 · Cited by 19
“…methadone is well established when taken at the recommended dosage, and long-term maintenance treatment has been associated with such outcomes as reduced use of opioids and reduced criminal activity (Reist 2010; Ward et al. 1994; Gossop 2006; Gossop et al. 2001; SACDM Methadone Project Group 2007).”
BackgroundSelf-citationThe lure and the loss of harm reduction in UK drug policy and practice
McKeganey, N. (2006) · Addiction Research & Theory · doi:10.1080/16066350601002369 · Cited by 20
“Frustrated by the failure of English methadone services either to commit to treatment or to harm reduction, Gossop et al. (2001) called for a ‘‘clearer distinction between reduction treatments and the long-term, stable-dose maintenance treatments which are designed to achieve harm reduction…”
BackgroundSoyka, M., & Franke, A. G. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i9.543 · Cited by 19
Using ‘payment by results’ to fund the treatment of dependent drug users—proceed with care!
Maynard, A., Street, A., & Hunter, R. M. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03503.x · Cited by 18
Parmenter, J., Mitchell, C. A., Keen, J., Oliver, P., Rowse, G., Neligan, I., Keil, C., & Mathers, N. J. (2013) · British Journal of General Practice · doi:10.3399/bjgp13x669220 · Cited by 17
Roux, P., Carrieri, P., Cohen, J., Ravaux, I., Spire, B., Gossop, M., & Comer, S. D. (2011) · Harm Reduction Journal · doi:10.1186/1477-7517-8-31 · Cited by 17
“Although the association between time since OMT initiation and non-medical use of opioids is not unexpected, it demonstrates that the longer the duration of OMT (retention in OMT), the better achievement of stabilization in terms of heroin use and OMT diversion [32].”
BackgroundSelf-citationWright, N. M. J., Sheard, L., Tompkins, C. N. E., Adams, C. E., Allgar, V. L., & Oldham, N. S. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-3 · Cited by 17
“This is in response to routine practice by some treatment providers of 'gradual reduction' of opiate maintenance treatment – a regimen without a supporting evidence base [2].”
BackgroundA Qualitative Study of Prescribing Doctor Experiences of Methadone Maintenance Treatment
Hout, M. C. V., & Bingham, T. (2013) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-013-9436-3 · Cited by 16
“2003), with objectives ranging from harm reduction (Roe 2005), to long term maintenance (Ball and Ross 1991) to abstinence from all drugs (Gossop et al. 2001).”
BackgroundChanges to the daily pattern of methadone-related deaths in England and Wales, 1993–2003
Morgan, O. W., Johnson, H., Rooney, C., Seagroatt, V. A., & Griffiths, C. (2006) · Journal of Public Health · doi:10.1093/pubmed/fdl059 · Cited by 15
Methadone Maintenance Therapy in Residential Therapeutic Conmmunity Settings: Challenges and Promise
Greenberg, B., Hall, D. H., & Sorensen, J. L. (2007) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2007.10400606 · Cited by 14
Bennett, G. A., Edwards, S. H., & Bailey, J. (2002) · Journal of Substance Use · doi:10.1080/14659890215694 · Cited by 14
“…entering treatment in England in 1995 National Treatment Outcome Research Study (NTORS), found substantial and widespread improvements in patients receiving methadone treatment in the community – whether the intended treatment initially aimed at detoxification or maintenance (Gossop et al. 2001).”
BackgroundExiting Prostitution: A Study in Female Desistance
Matthews, R., Easton, H., Young, L., & Bindel, J. (2014) · doi:10.1057/9781137289421 · Cited by 14
Methadone Treatment in Clinical Practice in Italy: Need for Improvement
Schifano, P., Bargagli, A. M., Belleudi, V., Amato, L., Davoli, M., Diecidue, R., Versino, E., Vigna‐Taglianti, F., Faggiano, F., & Perucci, C. A. (2006) · European Addiction Research · doi:10.1159/000092113 · Cited by 14
“Higher doses have been consistently shown to encourage treatment retention and reduction in illicit drug use in MMTs. A comprehensive review [ ,”
BackgroundBloor, M., McIntosh, J., McKeganey, N., & Robertson, M. (2008) · Public Health · doi:10.1016/j.puhe.2008.01.007 · Cited by 14
Monthly Take-Home Methadone Maintenance Regime for Elderly Opium-Dependent Users in Singapore
Song, G., Winslow, M., Manning, V., & Thane, K. K. W. (2010) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v39n6p429 · Cited by 14
Abstinence-orientated buprenorphine replacement therapy for young adults in out-patient counselling
Kornør, H., Waal, H., & Ali, R. L. (2006) · Drug and Alcohol Review · doi:10.1080/09595230500537209 · Cited by 12
A Perspective on Opioid Pharmacotherapy: Where We Are and How We Got Here
Ling, W. W. (2016) · Journal of Neuroimmune Pharmacology · doi:10.1007/s11481-016-9663-z · Cited by 13
“Although methadone’s safety and efficacy had been long recognized (Gossop et al., 2001; Marsch, 1998), its clinical use was not widely embraced.”
BackgroundTreatment outcomes: what we know and what we need to know.
Gossop, M. (2005) · Cited by 12
Self-citationLivingston, W., Baker, M., Jobber, S., & Atkins, B. (2011) · Journal of Groups in Addiction & Recovery · doi:10.1080/1556035x.2011.571134 · Cited by 11
“As with any form of stigma, the longer this continues, the more self-reinforcing and identity fulfilling the stereotype becomes (eg, Goffman, 1968 ).”
Background
Metadata
- 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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