Withdrawal from methadone maintenance treatment: prognosis and participantperspectives

Objective: To determine the proportion of clients engaged in methadone main tenance treatment who have favourable prognosis for withdrawal, and to exam ine client perceptions and expectations of withdrawal. Methods: A broad cross-section of 856 methadone clients was sampled across Melbourne, Sydney and Brisbane. Self complete surveys were developed for th e clients, their clinic staff or pharmacists, and methadone prescribers. Th e client survey examined aspects of the clients' perspectives of withdrawal , and the surveys for the service providers collected information about eac h client's current treatment episode. Informed consent was provided by clie nts to obtain information from their clinic staff member or pharmacist, and their methadone prescriber. Results: Most clients (70%) were at least very interested in methadone with drawal. Clients were also more optimistic about their own post-withdrawal o utcomes tin terms of opioid use) than both their clinic staff and prescribi ng doctors. Clinical criteria indicated that 31% of clients had a reasonabl e prognosis for withdrawal. However, when considering all factors, 17% had good withdrawal prognosis, were interested in methadone withdrawal, and bel ieved it was very likely they would remain opioid-free for three months pos t-withdrawal. Conclusions: Despite the likely continued increase in client numbers in sub stitution maintenance treatment, the majority of methadone clients have a p oor prognosis for withdrawal and should not be encouraged to cease treatmen t. Implications: Clients who do not meet key clinical criteria are likely t o have poor clinical outcomes regardless of how withdrawal is attempted.