Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study

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 reductio ns in their use of illicit drugs and in other outcome areas. However, where as most methadone maintenance patients received maintenance, only about one third of those allocated to methadone reduction received methadone reducti on, and many actually received a form of methadone maintenance. Reduction p atients were more likely to receive low doses of methadone, and were less l ikely to remain in treatment. For maintenance patients, higher doses and re tention in treatment were both associated with improvements in illicit hero in use at 2 years. For the reduction patients, the more rapidly the methado ne was reduced, the worse the heroin use outcomes. For patients in both tre atment conditions, reductions in heroin use were associated with improvemen ts in other outcome areas. The more severely dependent patients showed bett er outcomes in methadone maintenance. Methadone reduction treatment process es were associated with poor outcomes, and many patients who were allocated to methadone reduction treatment did not receive reduction treatment as in tended. This calls into question the appropriateness of either the initial treatment planning process or the treatment delivery process, or both. A cl earer distinction should be made between methadone maintenance and methadon e reduction. Treatment goals should be made explicit both to the patient an d 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. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.