Predictors for completing an inpatient detoxification program among intravenous heroin users, methadone substituted and codeine substituted patients

Up to 1999 more opioid dependent patients in Germany were substituted with codeine or dihydrocodeine (summarised as codeine) than with methadone. The current retrospective study compares the differences in detoxification trea tment outcome for codeine-substituted patients, methadone-substituted patie nts and patients injecting illicit heroin. The study is based on the medica l records of 1070 patients admitted consecutively for opioid and polytox de toxification between 1991 and 1997. The main hypothesis was that injecting illicit-heroin users would complete detoxification treatment less often tha n codeine- or methadone-substituted patients, and that methadone-substitute d patients who had received more structured treatment would complete more o ften than codeine-substituted patients who did not receive any structured t reatment beyond the prescription of codeine. We analysed a number of demogr aphic and drug related variables as possible predictors. Our bivariate anal yses confirmed our main hypothesis: 50.4%, (OR: 1.8) of the methadone-subst ituted patients, 45.5% (OR: 1.5) of the codeine-substituted patients and 35 .9% (OR: I comparison group) of the injecting illicit-heroin users complete d the detoxification program (P = 0.006). This finding remained significant even after correcting for a number of confounders. Using stepwise multiple logistic regression analyses, we found age, education, history of imprison ment, regular contact with a counsellor, currently being on probation and r eported plans for participating in an abstinence treatment program to be si gnificant predictors of completing detoxification treatment. Although the c urrent analysis did not rule out differences in pharmacological effects as a contributing factor, the results are consistent with an interpretation of a dose-response association between psychosocial/psychotherapeutic support and detoxification outcome. More psychosocial/psychotherapeutic support le ads to better detoxification treatment response. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.