OUTCOMES OF TREATMENT OF SOCIALLY REHABILITATED METHADONE-MAINTENANCEPATIENTS IN PHYSICIANS OFFICES (MEDICAL MAINTENANCE) - FOLLOW-UP AT 3-1 2 TO 9-1/4 YEARS/

Objective: To determine whether selected socially rehabilitated former heroin addicts maintained on methadone can continue successful rehabi litation while maintained on methadone by primary care physicians rath er than licensed clinics. This procedure has been termed ''medical mai ntenance.'' Design: Cohort study with 42-111 months of follow-up. Sett ing: Offices of hospital staff physicians (internists or family practi tioners). Patients: The 100 patients met extensive entry criteria, inc luding five or more years in conventional methadone maintenance treatm ent; stable employment or other productive activity; verifiable financ ial support; and no criminal involvement, use of illegal drugs, or exc essive alcohol use within three or more years. Measurements and main r esults: Outcome measures used were retention in treatment, discharge f or one of several reasons, lost medication incidents, and substance ab use. At one, two, and three years of treatment, 98, 95, and 85 patient s, respectively, remained in medical maintenance. Cumulative proportio nal survival in treatment was 0.735 +/- 0.048 at five years and 0.562 +/- 0.084 at nine years. After 42 - 111 months, 72 patients remained i n good standing; 15 patients had unfavorable discharges (11 for cocain e use, three for misuse of medication, and one for administrative viol ations); seven voluntarily withdrew from methadone in good standing (a fter receiving it for 9.1 - 24.4 years); four died; one transferred to a chronic care facility and one voluntarily left the program. Conclus ions: Carefully selected methadone maintenance patients in medical mai ntenance have a high retention rate and a low incidence of substance a buse and lost medication. Voluntary withdrawal from methadone maintena nce after one or two decades is possible. The authors believe that med ical maintenance should be made available to appropriate patients in o ther localities.