Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: A randomized controlled trial

Context Despite evidence that methadone maintenance treatment (MMT) is effe ctive for opioid dependence, it remains a controversial therapy because of its indefinite provision of a dependence-producing medication. Objective To compare outcomes of patients with opioid dependence treated wi th MMT vs an alternative treatment, psychosocially enriched 180-day methado ne-assisted detoxification. Design Randomized controlled trial conducted from May 1995 to April 1999. Setting Research clinic In an established drug treatment service. Patients Of 858 volunteers screened, 179 adults with diagnosed opioid depen dence were randomized into the study, 154 completed 12 weeks of follow-up. Interventions Patients were randomized to MMT (n = 91), which required 2 ho urs of psychosocial therapy per week during the first 6 months; or detoxifi cation (n = 88), which required 3 hours of psychosocial therapy per week, 1 4 education sessions, and 1 hour of cocaine group therapy, if appropriate, for 6 months, and 6 months of (non-methadone) aftercare services. Main Outcome Measures Treatment retention, heroin and cocaine abstinence (b y self-report and monthly urinalysis), human immunodeficiency virus (HIV) r isk behaviors (Risk of AIDS Behavior scale store), and function in 5 proble m areas: employment, family, psychiatric, legal,:and alcohol use (Addiction Severity Index), compared by intervention group. Results Methadone maintenance therapy resulted in greater treatment retenti on (median, 438.5 vs 174.0 days) and lower heroin use rates than did detoxi fication, Cocaine use was more closely related to study dropout in detoxifi cation than in MMT, Methadone maintenance therapy resulted in a lower rate of drug-related (mean [SD] at 12 months, 2.17 [3.88] vs 3.73 [6.86]) but no t sex-related HIV risk behaviors and in a lower severity score for legal st atus (mean [SD] at 12 months, 0.05 [0.13] vs 0.13 [0.19]). There were no di fferences between groups in employment or family functioning or alcohol use . In both groups, monthly heroin use rates were 50% or greater, but days of use per month dropped markedly from baseline. Conclusions Our results confirm the usefulness of MMT in reducing heroin us e and HIV risk behaviors. Illicit opioid use continued in both groups, but frequency was reduced. Results do not provide support for diverting resourc es from MMT into longterm detoxification.