Patterns of Abstinence or Continued Drug Use Among Methadone Maintenance Patients and Their Relation to Treatment Retention

Abstract

The efficacy and effectiveness of methadone maintenance treatment (MMT) in the medical management of opioid addiction has been well-established, but treatment outcomes are compromised by the continued use of licit and illicit drugs during MMT. The present study examined the relationship between in-treatment illicit drug use and retention and dropout of 604 MMT patients in Washington, D.C. Sixty-eight percent of patients did not test positive for an unprescribed drug during the study period. Of patients who tested positive for an illicit drug during the baseline period, 55% tested positive for cocaine, 44% for opiates, 23% for THC, 20% for benzodiazepines, 7% for PCP, and 4% for amphetamines. Those testing positive were three times more likely to leave treatment than those who did not test positive. Testing positive for one drug doubled the rate of attrition; testing positive for multiple drugs quadrupled the risk of attrition. Non-prescribed opioid or benzodiazepine use was a predictor of MMT dropout, but prescribed opioid or benzodiazepine use was not. Continued illicit drug use poses significant risk for subsequent premature termination of MMT. Assertive clinical management of continued illicit drug use could provide mechanisms to enhance MMT retention and long-term recovery outcomes.

Keywords:

• benzodiazepines
• medication-assisted treatment
• methadone maintenance
• treatment retention

The authors would like to acknowledge the helpful early review, comments, and suggestions of the following persons: A. Thomas McLellan, Ph.D.; Lisa J. Merlo, Ph.D., P.P.E.; and Gary Reisfield, M.D.

Notes

1. 1.The absolute frequency of positive tests could not be used for these analyses since patients had anywhere from 3 to 15 tests during baseline. The percentage of tests that were positive for each individual was calculated by dividing the number of positives for illicit, unprescribed drugs by the number of times the individual was tested and multiplying by 100.