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Cited by 13Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China

Open access
Lu, Qian, Zou, Xia, Liu, Yin, Gong, Cheng, Ling, Li·2019·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph16152800PMC PMC6695604
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Abstract

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%–89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%–89% of the tapering phase increased the odds of heroin abstinence.

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Crossref · 10.3390/ijerph16152800

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  • Tapering at a rate <5%/week doubled the chance of stopping opioids compared with tapering at a rate of 5%-10%/week.

    “In another study population, tapering at a rate <5%/week doubled the chance of stopping opioids compared with tapering at a rate of 5%–10%/week. 45”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [45]

    The Results (§3.3) report that tapering at <5% per week, compared with 5%–10% per week, was associated with about twice the odds of heroin abstinence during the tapering phase (OR 2.08). The study measured negative urine morphine tests during tapering, not whether participants stopped opioids; it also reports odds rather than a doubled probability. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Patients who tapered at less than 5 mg of methadone per week had a 5-fold increased chance of heroin abstinence compared with people who tapered at more than 10 mg of methadone per week.

    “Patients who tapered at less than 5 mg of methadone per week had a 5-fold increased chance of a positive outcome (in this case, heroin abstinence) compared with people who tapered at more than 10 mg of methadone per week. 45”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [45]

    Results §3.2 identifies a taper-dose category below 5 mg/week, and Results §3.3 says tapering characteristics were associated with heroin abstinence. But the reported odds ratio of 2.08 concerns a different measure—less than 5% per week versus 5–10% per week. The available passages do not establish a fivefold difference between the stated mg/week groups (page numbers unavailable). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In a study in China, only 38.7% of patients tapered in the 5%-10%/week range.

    “Another study in China had similar findings: with 50.4% of patients tapered faster than guidelines recommend (>10% of the original dose/week), with only 38.7% of patients tapered in the 5%–10%/week range and only 10.9% tapered at <5% of the previous dose per week (the rate most likely to produce heroin abstinence at study end). 45”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [45]

    Results §3.2 reports that 38.7% of treatment episodes had a taper ratio of 5%–10% per week in the Guangdong study. The claim says 38.7% of patients, but Definitions §2.3.1 says a participant could have more than one treatment episode, so the patient-level percentage is not established. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a study in China, 50.4% of patients tapered faster than guidelines recommend (>10% of the original dose/week).

    “Another study in China had similar findings: with 50.4% of patients tapered faster than guidelines recommend (>10% of the original dose/week), with only 38.7% of patients tapered in the 5%–10%/week range and only 10.9% tapered at <5% of the previous dose per week (the rate most likely to produce heroin abstinence at study end). 45”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [45]

    Results §3.2 reports that 50.4% of treatment episodes had a taper ratio above 10% per week, faster than the rate recommended by other countries’ guidelines. But Methods §2.3 defines that ratio relative to the previous week’s dose, not the original dose; the study also reports treatment episodes rather than a percentage of distinct patients. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a study in China, only 10.9% of patients tapered at <5% of the previous dose per week, the rate most likely to produce heroin abstinence at study end.

    “Another study in China had similar findings: with 50.4% of patients tapered faster than guidelines recommend (>10% of the original dose/week), with only 38.7% of patients tapered in the 5%–10%/week range and only 10.9% tapered at <5% of the previous dose per week (the rate most likely to produce heroin abstinence at study end). 45”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [45]

    Results §3.2 reports that 50.4% of treatment episodes tapered at >10% per week and 38.7% at 5%–10% per week, leaving 10.9% at <5% per week. Results §3.3 associates <5% per week with higher odds of heroin abstinence, and Methods §2.3 defines the ratio relative to the previous dose. The claim's 'at study end' qualifier is not supported: Methods §2.5.1 defines abstinence as having no positive urine tests throughout the tapering phase, not as an end-of-study result. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 3

  1. [6]Center for Substance Abuse, Treatment Samhsa/Csat Treatment Improvement Protocols Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs Substance Abuse and Mental Health Services Administration Rockville, MD, USA 2005 22514849
  2. [21]Deng S. Weng S. Investigation Report About the Trend Change of Drug Addicts in Guangdong Province Justice China 2017 85 91 10.3969/j.issn.1009-329X.2017.03.019 · DOI
  3. [34]WHO Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence WHO Geneva, Switzerland 2009 23762965

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Authors
Lu, Q., Zou, X., Liu, Y., Gong, C., & Ling, L.
Affiliations
  • Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
  • Sun Yat-sen University (CN)
ORCID
Zou, Xia
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2019-08-06
Volume
16
Issue
15
Pages
2800
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph16152800
PMC
PMC6695604
OpenAlex
W2964970574
Cited by
13
References
29
Citations by year
2026: 2 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 2
FWCI
0.46
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Natural Science Foundation of China (81473065)
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, heroin abstinence, dose tapering, opioid use disorder, opioid substitution therapy
MeSH terms
Adult, China, Female, Heroin Dependence, Humans, Male, Methadone, Middle Aged, Retrospective Studies, Logistic Models, Opiate Substitution Treatment

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