New research clearly shows that longer-term methadone maintenance therapy (MMT), combined with some psychosocial counseling, is a far more effective treatment for heroin addiction than is simply the temporary use of methadone to detoxify patients and reduce drug craving, even when the detoxification is coupled with much more intensive psychosocial therapy. The study is published in this week's Journal of the American Medical Association, by a research team from the University of California, San Francisco, and the San Francisco Veteran Affairs Medical Center. The National Institute on Drug Abuse (NIDA), National Institutes of Health, provided funding for the research.
"The findings from this study clearly indicate that methadone maintenance is an effective treatment for heroin addiction," says Dr. Alan I. Leshner, NIDA Director. "This is yet another indication that MMT should be used more widely as a treatment option for heroin addicts. Currently, only about 20 percent of the 810,000* diagnosed heroin addicts in the U.S. receive this treatment."
Study director Dr. Sharon Hall says, "The goal of this study was to determine whether short-term methadone-assisted detoxification, when enriched with intensive psychosocial services and aftercare, could provide an effective alternative to MMT. Our results show that no matter how ideologically attractive the notion of a time-limited methadone treatment for heroin abusers, longer-term methadone maintenance treatment is far more effective."
The researchers interviewed 179 heroin- or cocaine-dependent volunteers monthly, for 12 months after their admission to the study. The volunteers were randomly divided into two groups - a methadone maintenance treatment group and a methadone detoxification group. The MMT group was eligible for 14 months of methadone maintenance, followed by a 2-month detoxification. Participants in this group were required to attend substance abuse group therapy 1 hour per week for the first 6 months of maintenance, and 1 hour per month of individual therapy.
Patients in the detoxification group received methadone only for the first 180 days of their treatment. During their first 6 months of treatment, the detoxification group was required to attend 2 hours per week of substance abuse group therapy; 1 hour per week of cocaine group therapy (if they had tested positive for cocaine when admitted to the study); a series of 14 1-hour, weekly substance abuse education classes; and 4 weekly individual therapy sessions. This group also received 6 months of aftercare services that included weekly individual and group psychotherapy and liaison services with the criminal justice system, medical clinics, and social service agencies, but no additional methadone after the first 180 days of their treatment.
Study results showed that more patients in the MMT group remained in treatment for longer periods of time (438.5 days vs. 174 days) and had lower heroin use rates than did shorter-term methadone detoxification patients. Of the MMT group, 77 out of 91 patients were still in the study at the 12-month mark, while only 57 of 88 methadone detoxification patients were still in the study. MMT also resulted in a lower rate of drug use-related HIV-risk behaviors and a lower level of criminal activity.
Note to Reporters: The full text of the article, "Methadone Maintenance versus 180-day Psychosocially-Enriched Detoxification for Treatment of Opioid Dependence: A Randomized, Controlled Trial," can be found in the March 8, 2000, issue of The Journal of the American Medical Association (JAMA.2000;283:1303-1310). The article is available on JAMA's website at: http://www.jama.com or by calling the Science News Department at 312-464-5374.
*Figure from The White House Office of National Drug Control Policy.