European Addiction Research

Research Report

Eyes Wide Shut? – A Conceptual and Empirical Critique of Methadone Maintenance Treatment

Fischer B.a, b · Rehm J.a, b,c · Kim G.a, b · Kirst M.b

Author affiliations

aUniversity of Toronto, bCentre for Addiction and Mental Health, Toronto, Canada; cAddiction Research Institute, Zurich, Switzerland

Keywords: Opioid dependenceMethadone maintenance treatmentTreatment evaluationQuality of lifeSelf-medication

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Eur Addict Res 2005;11:1–14
https://doi.org/10.1159/000081410

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Article / Publication Details

First-Page Preview
Abstract of Research Report

Published online: December 10, 2004
Issue release date: December 2004

Number of Print Pages: 14
Number of Figures: 0
Number of Tables: 0

ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)

For additional information: https://www.karger.com/EAR

Abstract

Background: Methadone maintenance treatment (MMT) has been the ‘gold standard’ pharmacotherapy treatment for illicit opioid dependence for over 30 years. It has been widely evaluated, and is generally claimed to be ‘effective’. Methods: The objective of this paper is to review the rationale of MMT as an intervention for a biomedical disorder with primary social objectives as well as the methodological quality and evidence of MMT outcome research. Data sources included opioid dependence treatment practice, review and outcome research literature (1965–2001) in the form of peer-reviewed articles, books, monographs and reports that are preeminently cited and reviewed international studies on MMT. Results/Data Synthesis: Rigorous and appropriate evaluation (i.e., RCTs, intent-to-treat, patient-centered) methods in MMT evaluations are rare. Evidence of MMT’s effectiveness on primary treatment objectives is mixed and appears to be largely partial and short-term. Positive outcomes may be the result of selection effects of compliant patients and loss in proportion when more rigorous standards of analysis are applied. Conclusions: The quality of existing MMT research, and evidence for its general effectiveness are limited. Key concepts of self-medication and psychiatric comorbidity are largely ignored in MMT treatment and research frameworks, although they may serve to explain MMT’s limited treatment success. Emerging new opioid pharmacotherapies require the fundamental review of the existing MMT paradigm as well as the application of rigorous and appropriate evaluation methods for future treatment.

© 2005 S. Karger AG, Basel



Related Articles:

References

  1. Farrell M, Verster A, Davoli M, Nilson M, Merino P: Reviewing current practice in drug-substitution treatment in the European Union. Luxembourg, Office for Official Publications of the European Communities, 2000.
  2. European Monitoring Centre for Drugs and Drug Addiction: Annual report on the state of the drugs problem in the European Union. Luxembourg, Office for Official Publications of the European Communities, 2000.
  3. Hall W, Lynskey M, Degenhardt L: Heroin use in Australia: Its impact on public health and public order. Sydney, National Drug and Alcohol Research Centre, 1999.
  4. Kuo I, Fischer B, Vlahov D: Consideration of a North American heroin-assisted trial for the treatment of opiate-dependent individuals. Int J Drug Policy 2000;11:357–370.
    External Resources
  5. Dole V, Nyswander M: A medical treatment for diacetylmorphine (heroin) addiction. J Am Med Assoc 1965;193:646–650.
    External Resources
  6. Halliday R: Management of the Narcotic Addict. Br Columbia Med J 1963;5:412–414.
  7. Fischer B, Rehm J, Kirst M, Casas M, Hall W, Krausz M, Metrebian N, Reggers J, Uchtenhagen A, van den Brink W, Van Ree J: Heroin-assisted treatment as a response to the public health problem of opiate dependence. Eur J Public Health, under review.
  8. Farrell M, Ward J, Mattick R, Hall W, Stimson G, Des Jarlais D, Gossop M, Strang J: Methadone maintenance treatment in opiate dependence: A review. Br Med J 1994;309:997–1001.
    External Resources
  9. NIDA: Methadone Maintenance Treatment: Translating research into policy. Bethesda, National Institute on Drug Abuse, 1995.
  10. National Institutes of Health: National consensus development panel on effective medical treatment of opiate addiction. JAMA 1998;280:1936–1943.
    External Resources
  11. Rehm J, Fischer B: Heroingestützte Therapie für Opiatabhängige weder Allheilmittel noch Teufelswerk. Suchttherapie 2000;01:57–62.
    External Resources
  12. Dole VP, Nyswander M, Kreek M: Narcotic blockade. Arch Int Med 1966;118:304–309.
    External Resources
  13. Lowinson J, Marion I, Joseph H, Dole V: Methadone maintenance; in Lowinson JH, Ruiz P, Millman RB, Langrod JG (eds): Substance Abuse: A Comprehensive Textbook, ed 2. Philadelphia, Williams & Wilkins, 1992, pp 550–561.
  14. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiological Catchment Area (ECA) Study. JAMA 1990;264:2511–2518.
    External Resources
  15. Ball JC, Ross A: The effectiveness of methadone maintenance treatment: Patients, programs, services and outcomes. New York, Springer, 1991.
  16. Maxwell S, Shinderman M: Optimizing response to methadone maintenance treatment: Higher dose methadone. Heroin Addict Relat Clin Probl 2000;2:53–54.
  17. Fischer B, Rehm J: The case for a heroin substitution treatment trial in Canada. Can J Public Health 1997;88:367–370.
    External Resources
  18. Bammer G, Dobler-Mikola A, Fleming P, Strang J, Uchtenhagen A: The heroin prescribing debate: Integrating science and politics. Science 1999;284:1277–1278.
    External Resources
  19. NIDA: Principles of Drug Addiction Treatment: A Research-Based Guide. Bethesda, National Institute on Drug Abuse, National Institutes of Health, 1999.
  20. Ward J, Hall W, Mattick R: Role of methadone maintenance in opioid dependence. Lancet 1999;353:221–226.
    External Resources
  21. Bertschy G: Methadone maintenance treatment: An update. Eur Arch Psychiatry Clin Neurosci 1995;245:114–124.
    External Resources
  22. Wall R, Rehm J, Fischer B, Brands B, Gliksman L, Stewart J, Medved W, Blake J: The social cost of untreated opiate use. J Urban Health 2001;77:688–722.
    External Resources
  23. Barnett P: The cost-effectiveness of methadone maintenance as a health care intervention. Addiction 1999;94:479–488.
    External Resources
  24. Barnett P, Hui S: The cost-effectiveness of methadone maintenance. Mt Sinai J Med 2000;67:365–374.
    External Resources
  25. Frei A, Greiner R, Mehnert A, Dinkel R: Socioeconomic evaluation of the trials for the medical prescription of opiates, final report; in Gutzwiller F, Steffen T (eds): Cost Benefit Analysis of Heroin Maintenance Treatment. Basel, Karger, 2000.
  26. Fishman M: Crime waves as ideology. Soc Probl 1978;25:543.
  27. Chambliss W: Criminal law in action. Santa Barbara, Hamilton, 1975, pp 1–477.
  28. Wood-Dauphinee S: Assessing quality of life in clinical research: From where have we come and where are we going? J Clin Epidemiol 1999;52:355–363.
    External Resources
  29. Sanders C, Egger M, Donovan J, Tallon D, Frankel S: Reporting on quality of life in randomised controlled trials: Bibliographic study. BMJ 1998;317:1191–1194.
    External Resources
  30. Fischer B, Rehm J, Kim G: ‘Quality of Life’ (QoL) in illicit opiate addiction research and treatment: Concepts, evidence, questions; in Westermann B, Jellinek C, Bellman G (eds): Substitution: Zwischen Leben und Sterben. Weilheim, Beltz Deutscher Studien Verlag, in press.
  31. Simpson DD, Sells SB: Effectiveness of treatment for drug abuse: An overview of the DARP research program. Adv Alcohol Subst Abuse 1982;51:7–29.
  32. Wasserman D, Korcha R, Havassy B, Hall S: Detection of illicit opioid and cocaine use in methadone maintenance treatment. Am J Drug Alcohol Abuse 1999;25:561–571.
    External Resources
  33. Chutuape M, Silverman K, Stitzer M: Use of methadone take-home contingencies with persistent opiate and cocaine abusers. J Subst Abuse Treat 1999;16:23–30.
    External Resources
  34. Saxon A, Calsyn D, Kivlahan D, Roszell D: Outcome of contingency contracting for illicit drug use in a methadone maintenance program. Drug Alcohol Depend 1993;31:205–214.
    External Resources
  35. Rosenbaum M: A matter of style: Variation among methadone clinics in the control of clients. Contemp Drug Probl 1985;Fall:375–399.
  36. Zweben JE: Counseling issues in methadone maintenance treatment. J Psychoactive Drugs 1991;23:177–190.
    External Resources
  37. Kleinman P, Lukoff I, Kail B: The magic fix: A critical analysis of methadone maintenance treatment. Soc Probl 1977;25:208–214.
    External Resources
  38. Fischer B, Kirst M, Rehm J, Marsh D, Bondy S, Tyndall M: The phenomenon of so-called ‘other drug use’ among opiate addicts in the North American context: Evidence, consequences, questions; in Westermann B, Bellman G, Jellinek C (eds): Beigebrauch: Offene Grenzen der Substitution. Weilheim, Beltz Deutscher Studien Verlag, 2000.
  39. Committee on Federal Regulation of Methadone Treatment and Institute of Medicine: Federal Regulation of Methadone Treatment. Rettig R, Yarmolinsky A (eds), Washington, National Academy Press, 1995.
  40. Reno R, Aiken L: Life activities and life quality of heroin addicts in and out of methadone treatment. Int J Addict 1993;28:211–232.
    External Resources
  41. Dazord A, Mino A, Page D, Broers B: Patients on methadone maintenance treatment in Geneva. Eur Psychiatry 1998;13:235–241.
    External Resources
  42. Torrens M, San L, Martinez A, Castillo C, Domingo-Dalvany A, Alonso J: Use of the Nottingham Health Profile for measuring health status of patients in methadone maintenance treatment. Addiction 1997;92:707–716.
    External Resources
  43. Torrens M, Domingo-Dalvany A, Alonso J, Castillo C: Methadone and quality of life. Lancet 1999;353:1101.
    External Resources
  44. Fischer B, Chin A, Kuo I, Kirst M, Vlahov D: Opiate users’ views on methadone and other opiate prescription treatment in Canada: A qualitative focus group study. Subst Use Misuse, in press.
  45. Koester S, Anderson K, Hoffer L: Active heroin injectors’ perceptions and use of methadone maintenance treatment: Cynical performance or self-prescribed risk reduction? Subst Use Misuse 1999;34:2135–2153.
    External Resources
  46. Neale J: Drugs users’ views of prescribed methadone. Drugs Educ Prev Policy 1998;5:33–45.
    External Resources
  47. Hunt D, Lipton D, Goldsmith D, Strug D, Spunt B: It takes your heart: The image of methadone maintenance in the addict world and its effects on recruitment into treatment. Int J Addict 1986;20:1751–1771.
    External Resources
  48. Goldsmith D, Hunt D, Lipton D, Strug D: Le folklore de la methadone: Impact de certaines croyances sur le traitement. Psychotropes 1985;2:59–71.
  49. Rosenbaum M, Murphy S: Getting the treatment: Recycling women addicts. J Psychoact Drugs 1981;13:1–13.
    External Resources
  50. Brown B, Benn G, Jansen D: Methadone maintenance: Some client opinions. Am J Psychiatry 1975;132:623–626.
    External Resources
  51. Hunt G, Rosenbaum M: ‘Hustling’ within the clinic: Consumer perspectives on methadone maintenance treatment; in Inciardi J, Harrison L (eds): Heroin in the Age of Crack-Cocaine, ed 6. London, Sage Publications, 1998, pp 188–214.
  52. Dole VP, Robinson J, Orraca J, et al: Methadone treatment of randomly selected criminal addicts. New Engl J Med 1969;280:1372–1375.
    External Resources
  53. Newman R, Whitehill W: Double-blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong. Lancet 1979;2:485–488.
    External Resources
  54. Strain E, Stitzer M, Liebson IA, Bigelow G: Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psychiatry 1994;151:1025.
    External Resources
  55. Rehm J, Uchtenhagen A, Dombrowski D: Metaanalyse schweizerischer Arbeiten zur Verwendung von Methadon als Substitutionsmittel bei der Behandlung von Opioidabhängigkeit. Zürich, Institut für Suchtforschung, 2001.
  56. United States General Accounting Office: Methadone maintenance: Some treatment programs are not effective, greater federal oversight needed: Report to the Chairman, Select Committee on Narcotics Abuse and Control, House of Representatives. Washington, 1990, pp 1–37.
  57. Newman R, Des Jarlais D: Criteria for judging methadone maintenance programs. JAMA 1991;265:2190–2191.
    External Resources
  58. Ward J, Mattick RP, Hall W: Methadone maintenance and other opioid replacement therapies. Amsterdam, Harwood Academic, 1998.
  59. Hunt D, Strug D, Goldsmith D, Lipton D, Spunt B, Truitt L, Robertson K: Alcohol use and abuse: Heavy drinking among methadone clients. Am J Drug Alcohol Abuse 1984;12:147–164.
    External Resources
  60. Hunt D, Strug D, Goldsmith D, Lipton D, Spunt B, Truitt L, Robertson K: An instant shot of ‘aah’: Cocaine use among methadone clients. J Psychoact Drugs 1984;16:217–227.
    External Resources
  61. Fontaine P, Ansseau M: Aspects pharmaco-cliniques de la methadone. Encephale 1995;21:167–179.
    External Resources
  62. Hubbard R, Craddock S, Flynn P, Anderson J, Ethridge R: Overview of 1 year follow-up outcomes in the drug abuse treatment outcome study (DATOS). Psychol Addict Behav 1997;11:261–278.
    External Resources
  63. Tyndall MW, Brooks R, Currie S, Li K, O’Shaughnessy M, Schechter MT: Injection drug use among those on methadone maintenance treatment (abstract 346P). Can J Infect Dis 2000;11:66B.
  64. Best D, Harris J, Gossop M, Farrell M, Finch E, Noble A, Strang J: Use of non-prescribed methadone and other illicit drugs during methadone maintenance treatment. Drug Alcohol Rev 2000;19:9–16.
    External Resources
  65. Cushman P: Cocaine use in a population of drug abusers on methadone. Hosp Commun Psychiatry 1988;39:1205–1207.
  66. Shaffer H, LaSalvia T: Patterns of substance use among methadone maintenance patients. J Subst Abuse Treat 1992;9:143–147.
    External Resources
  67. Cochrane Review: LAAM maintenance vs. methadone maintenance for heroin dependence. The Cochrane Library. Oxford, Update Software, 2001.
  68. Uchtenhagen A: Substitutionsbehandlung der Opiatabhangigkeit; in Helmchen H, Henn F, Lauter H, Sartorius N (eds): Psychiatrie der Gegenwart, ed 4. Berlin, Springer, 2000, pp 602–628.
  69. Dobler-Mikola A, Pfeifer S, Müller V, Uchtenhagen A: Methadon- und Heroin- unterstützte Behandlung Opiatabhängiger im Vergleich. Zürich, Institut für Suchtforschung, 1998.
  70. Raskin V, Miller N: The epidemiology of the comorbidity of psychiatric and addictive disorders: A critical review. J Addict Dis 1993;12:45–57.
    External Resources
  71. Zimberg S: A dual diagnosis typology to improve diagnosis and treatment of dual disorder patients. J Psychoact Drugs 1999;31:47–51.
    External Resources
  72. Rettig R, Yarmolinsky A: Federal regulation of methadone treatment. Washington, National Academy Press, 1995.
  73. Krausz M, Degkwitz P, Kuhne A, Verthein U: Comorbidity of opiate dependence and mental disorders. Addict Behav 1998;23:767–783.
    External Resources
  74. Brienza R, Stein M, Chen M-H, Gogineni A, Sobota M, Maksad J, Hu P, Clarke J: Depression among needle exchange program and methadone maintenance clients. J Subst Abuse Treat 2000;18:331–337.
    External Resources
  75. Busto U, Romach M, Sellers E: Multiple drug use and psychiatric comorbidity in patients admitted to the hospital with severe benzodiazepine dependence. J Clin Psychopharmacol 1996;16:51–57.
    External Resources
  76. Darke S, Swift W, Hall W, Ross M: Drug use, HIV risk-taking and psychosocial correlates of benzodiazepine use among methadone maintenance clients. Drug Alcohol Depend 1994;31:31–36.
    External Resources
  77. Strain E, Brooner R, Bigelow G: Clustering of multiple substance use and psychiatric diagnoses in opiate addicts. Drug Alcohol Depend 1991;27:127–134.
    External Resources
  78. Weiss R, Griffin M, Mirin S: Drug abuse as self-medication for depression: An empirical study. Am J Alcohol Abuse 1992;18:121–129.
    External Resources
  79. Abraham H, Fava M: Order of onset of substance abuse and depression in a sample of depressed outpatients. Compr Psychiatry 1999;40:44–50.
    External Resources
  80. Schneier F, Siris S: A review of psychoactive substance use and abuse in schizophrenia. Patterns of drug choice. J Nerv Ment Dis 1987;175:641–652.
    External Resources
  81. Covey L, Glassman A, Stetner F: Cigarette smoking and major depression. J Addict Dis 1998;17:35–46.
    External Resources
  82. Gearon J, Bellack A, Rachbeisel J, Dixon L: Drug-use behavior and correlates in people with schizophrenia. Addict Behav 2001;26:51–61.
    External Resources
  83. Khantzian E: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American J Psychiatry 1985;142:1264.
  84. Blume A, Schmaling K, Marlatt G: Revisiting the self-medication hypothesis from a behavioral perspective. Cogn Behav Pract 2000;7:379–384.
    External Resources
  85. Mueser K, Drake R, Wallach M: Dual diagnosis: A review of etiological theories. Addict Behav 1998;23:717–734.
    External Resources
  86. Castaneda R: Empirical assessment of the self-medication hypothesis among dually diagnosed inpatients. Compr Psychiatry 1994;35:180–184.
    External Resources
  87. McLellan A, Arndt I, Metzger D, Woody G, O’Brien C: The effects of psychosocial services in substance abuse treatment. J Am MedAssoc 1993;269:1953–1959.
    External Resources
  88. Gill T, Feinstein A: A critical appraisal of the quality of quality-of-life measurements. JAMA 1994;272:619–626.
    External Resources
  89. Higginson I, Carr A: Measuring quality of life: Using quality of life measures in the clinical setting. BMJ 2001;322:1297–1300.
    External Resources
  90. Carr A, Higginson I: Are quality of life measures patient centred? BMJ 2001;322:1357–1360.
    External Resources
  91. Carroll K, Rounsaville B, Bryant K: Alcoholism in treatment-seeking cocaine abusers: Clinical and prognostic significance. Compr Psychiatry 1993;54:199–208.
    External Resources
  92. Ritter A, Kutin J, Lintzeris N, Bammer G: Expanding treatment options for heroin dependence in Victoria: Buprenorphine, LAAM, naltrexone and slow-release oral morphine, New Pharmacotherapies Project – Feasibility Phase. Fitzroy, Australia, Turning Point Alcohol and Drug Centre Inc., 1997.

Article / Publication Details

First-Page Preview
Abstract of Research Report

Published online: December 10, 2004
Issue release date: December 2004

Number of Print Pages: 14
Number of Figures: 0
Number of Tables: 0

ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)

For additional information: https://www.karger.com/EAR

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