Since 1967, 170 heroin addicts have used methadone-based maintenance therapy. The experimental programme, confined to the Uppsala Psychiatric Clinic, followed the Dole-Nyswander method. Evaluation of the results shows the therapy to be successful in reducing mortality and permanent disability rates in heroin users. In addition it was found that addicts included in the programme were more likely to achieve complete social rehabilitation. In spite of much criticism, the experiment was sufficiently successful to justify its continuation, though still within the limits and along the lines adopted in the past.
The present study attempts to shed light on methadone maintenance patients expectations regarding withdrawal symptoms during voluntary methadone detoxification. The study includes two groups of subjects; one group who have tried on their own initiative to terminate their methadone maintenance treatment (Group 1) and one group that contains rehabilitated patients who have not tried to quit using methadone (Group 2). Two main results have emerged. Group 1 has negative expectations beforehand about the intensity of withdrawal which significantly exceed the later, actual experience. Group 2 has negative expectations about the intensity of withdrawal that significantly exceed the negative expectations of Group 1. The clinical implications of these results are discussed.
In Denmark the official aim has been to reduce methadone treatment, even though no effort is made to directly forbid this therapy. A multiprofessional committee was established to regulate and limit methadone treatment. There were no specific guidelines for what type of drug addict should be treated with methadone. We found that allocation for the Regional Narcotic Committee of the Municipality of Copenhagen during 1982-1984 did not serve the desires of the addicts because only 41% followed it. Allocation also did not follow the principles of research in this field. In a 2-year follow-up investigation we found that drug addicts had a mortality rate of 6.3/year, rising criminality (significant), and falling availability to the labor market (nonsignificant). We therefore came to the conclusion that the efforts of the committee did not improve the conditions of drug addicts. Only those drug addicts who had been under almost constant methadone treatment had a low lethality and a falling number of criminal convictions (significant). Finally, it is concluded that limited research within this field prevents more specific treatment and improved use of financial resources.
An 18-year addiction career, 1985-2003, for 157 heroin dependent subjects (73% men; 49% human immunodeficiency virus seropositive) admitted for the first time to Stockholm's Methadone Maintenance Treatment program during 1989 to 1991 was analyzed with data from seven official registers and patient records. Regression analyses and incidence rates for various outcomes were calculated for subjects in first methadone maintenance treatment at the end of the observation period, discharged from first methadone maintenance treatment, in second methadone maintenance treatment, and discharged from second methadone maintenance treatment. Being human immunodeficiency virus positive (HR = 3.8), lodging (HR = 1.9) and prison sentence (HR = 1.7) predicted mortality for the 45% deceased. Approximately 70% of living subjects participated in methadone maintenance treatment at some period each year. Subjects in first or second methadone maintenance treatment had less criminality and had spent more time in methadone maintenance treatment (70% to 100%) than those discharged from first or from second methadone maintenance treatment (50%). Efforts and interventions should be intensified to increase time in treatment also for those with high problem severity.
We examined the association of methadone maintenance therapy (MMT) with highly active antiretroviral therapy (HAART) adherence and HIV treatment outcomes among a cohort of HIV/HCV co-infected injection drug users (IDUs).
We obtained demographic, drug use, and addiction care history from the Vancouver Injection Drug User Study (VIDUS), which is an open cohort study of IDUs. The questionnaires were longitudinally linked to the British Columbia HIV/AIDS Drug Treatment Program to obtain HAART adherence and HIV treatment outcome data. There were 278 VIDUS participants who accessed HAART from August 1, 1996 to November 24, 2003. We constructed longitudinal logistic models using generalized estimating equations to examine the independent associations between methadone maintenance therapy and the following outcomes: HAART adherence; plasma HIV-1 RNA suppression; and CD4 cell rise of 100cells/mm(3).
Among participants who reported at least weekly heroin use, MMT was independently associated with lower odds of subsequent weekly heroin use during the follow-up period (adjusted odds ratio; 95% confidence interval [AOR; 95% CI]: 0.24; 0.14-0.40). We also found that MMT was positively associated with adherence (AOR 1.52; 95% CI 1.16-2.00), HIV-1 RNA suppression (AOR 1.34; 95% CI 1.00-1.79), and CD4 cell count rise (AOR 1.58; 95% CI 1.26-1.99).
Among HIV/HCV co-infected IDUs on HAART, enrollment in MMT was associated with reduced heroin use, and improved adherence, HIV-1 RNA suppression and CD4 cell count response. Integrating opiate addiction care and HIV care may provide improved health outcomes for this vulnerable population and should be further explored.
Researchers have long neglected the user's perspective and experiences in assessing drug effects and drug use. With increased interest in Canada directed at prescribing heroin in place of methadone, researchers took the relatively unique approach of gathering data and information from methadone users to determine their views and experiences with methadone programs and alternative treatment choices. The results of that research portrayed very interesting and useful notions of users regarding methadone maintenance and the prescribing of heroin.
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Comment On: Subst Use Misuse. 2002 Mar;37(4):495-52212064431
BACKGROUND AND OBJECTIVES: The Beck Depression Inventory (BDI) is a widely used measure of depression severity in both research and clinical contexts. This study aimed at assessing its stability and associations with ongoing drug use in a sample of patients in opiate agonist maintenance treatment who were not abstinent from illicit drugs. DESIGN AND METHOD: The study was a prospective, naturalistic study. Subjects in enhanced or standard psychosocial services along with opiate agonist maintenance treatment were administered the BDI and the European Addiction Severity Index (EuropASI) twice by research technicians, approximately 2 weeks after intake and at 18 months follow-up. FINDINGS: There were rather small mean changes from intake to follow-up in the BDI, and mean-level stability in subjects was rather high as evidenced by a high intra-class correlation between intake score and follow-up score. The stability of the BDI was reduced at high levels of drug use severity at intake, and BDI was a moderate predictor of drug use severity at follow-up. CONCLUSIONS: The BDI measures a construct that is both stable and of predictive validity in a sample of non-abstinent opiate agonist maintenance patients, although very severe drug use at baseline appeared to reduce the stability of the BDI.
