TY - JOUR
T1 - Treatment initiation strategies for syringe exchange referrals to methadone maintenance
T2 - A randomized clinical trial
AU - Kidorf, Michael
AU - Brooner, Robert K.
AU - Leoutsakos, Jeannie Marie
AU - Peirce, Jessica
N1 - Funding Information:
National Institute of Drug Abuse (NIDA) provided financial support for the conduct of this research (RO1 DA 12347). NIDA had no role in the design of the study; the collection, analysis, or interpretation of the data; the writing of the report; or the decision to submit this research for publication.
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4–6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment.
AB - This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4–6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment.
KW - Methadone maintenance
KW - Syringe exchange
KW - Treatment initiation
KW - Treatment retention
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U2 - 10.1016/j.drugalcdep.2018.03.009
DO - 10.1016/j.drugalcdep.2018.03.009
M3 - Article
C2 - 29709732
AN - SCOPUS:85046129681
SN - 0376-8716
VL - 187
SP - 343
EP - 350
JO - Drug and alcohol dependence
JF - Drug and alcohol dependence
ER -