Patient-centered methadone treatment: a randomized clinical trial

Robert P. Schwartz, Sharon M. Kelly, Shannon G. Mitchell, Jan Gryczynski, Kevin E. O'Grady, Devang Gandhi, Yngvild Olsen, Jerome H. Jaffe

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual. Design: Two-arm open-label randomized trial. Setting: Two methadone treatment programs (MTPs) in Baltimore, MD, USA. Participants: Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. Intervention: Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151). Measurements: The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment. Findings: There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). Conclusions: Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.

Original languageEnglish (US)
Pages (from-to)454-464
Number of pages11
JournalAddiction
Volume112
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • Methadone treatment
  • opioid substitution therapy
  • opioid use disorder
  • patient-centered care
  • therapeutic alliance
  • treatment retention

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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