Interim Methadone Program Can Help Heroin Addicts

By Will Boggs, MD

NEW YORK (Reuters Health) – For heroin addicts waiting to get in to a comprehensive treatment program, an interim methadone maintenance program reduces heroin use and criminal activity, according to a new report.

"Although the original drug treatment programs in the United States emphasized the importance of counseling and other services with the methadone, our data suggest that when you cannot provide all of those services, just providing the methadone can make a tremendous improvement in the lives of heroin-addicted individuals," Dr. Robert P. Schwartz told Reuters Health.

Schwartz from Friends Research Institute, Inc. and University of Maryland School of Medicine, Baltimore, and colleagues explain that there are long waiting lists for entry into comprehensive methadone treatment programs. They compared interim treatment as an alternative to being on a waiting list, and assessed the potential of low-threshold services in reducing patients’ drug use and increasing their likelihood of entering comprehensive treatment.

Of 194 participants in interim treatment, only 31 (16.0 percent) dropped out of treatment before day 120 — the maxim duration of the interim program — the team reports in the January 2006 Archives of General Psychiatry.

After an average of 117 days of interim treatment, 75.9 percent of the participants entered comprehensive treatment, the report indicates, while only 20.8 percent of waiting list participants did so (after an average of 58.5 days).

Less than 60 percent of participants in interim treatment had a positive urine heroin test after entering the program, the researchers note, compared with 79.2 percent of participants on the waiting list. Most interim participants had no or only one positive heroin test after the study began.

During the last month of the study, the interim-treatment group reported substantially less money spent on drugs and less illegal income than did the waiting-list group, the investigators say.

"We are planning to conduct a cost-benefit analysis to determine the extent to which savings from differential rates of arrests, incarcerations, emergency room visits, and inpatient hospitalizations offset the cost of both comprehensive and interim treatment," Schwartz said.

He and his colleagues believe that interim treatment could have a high impact if it were adopted "on a large-scale in cities, such as Baltimore, with considerable numbers of heroin-addicted individuals on waiting lists."

However, there are barriers. "The main obstacle to implementing interim methadone maintenance is the restriction on clinical practice of two aspects of Federal regulations governing such programs," Schwartz explained.

"First, interim methadone treatment is restricted to a maximum of 120 days, after which time interim patients must be transferred to comprehensive treatment. This requirement sharply limits the ability of interim programs to admit heroin-addicted applicants, because programs must be certain that they will have a comprehensive treatment slot at the end of the interim period."

"Second," Schwartz continued, "programs must remain open on Sundays and major holidays (including Christmas Day). In Baltimore, this requirement prohibits half of the city’s treatment programs (which are open six days per week) from providing interim methadone treatment, thus limiting treatment capacity."

The net result of these obstacles is that "many individuals seeking drug addiction treatment are put on waiting lists while they continue to use heroin."

SOURCE: Archives of General Psychiatry, January 2006.