Supervised daily consumption, contingent take-home incentive and non-contingent take-home in methadone maintenance

• Published in: Progress in neuro-psychopharmacology & biological psychiatry 2011-03, Vol.35 (2), p.483-489
• Main Authors: Gerra, G., Saenz, E., Busse, A., Maremmani, I., Ciccocioppo, R., Zaimovic, A., Gerra, M.L., Amore, M., Manfredini, M., Donnini, C., Somaini, L.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Comorbidity; Contingent take-home; Crime; Drug Administration Schedule; Female; Heroin; Heroin Dependence - epidemiology; Heroin Dependence - rehabilitation; Humans; Interview, Psychological; Male; Medical sciences; Mental Disorders - epidemiology; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Motivation; Neuropharmacology; Non-contingent take-home; Opiate Substitution Treatment; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - rehabilitation; Patient Compliance; Pharmacology. Drug treatments; Self Report; Substance Abuse Detection; Substance-Related Disorders; Treatment Outcome; Violence
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2010.12.002

Methadone maintenance therapy (MMT) has been found effective in treating heroin addiction. Serious consideration should be given to the modality of methadone distribution, as it influences not only treatment outcome but the attitudes of policy makers and the community, too. On one hand, the choice of take-home methadone removes the need for daily attendance at a methadone clinic, which seems to improve patients' quality of life. On the other, this method, because of its lack of supervision and the absence of strict consumption monitoring, runs the risk of methadone misuse and diversion. In this study, we compared A) supervised daily consumption, B) contingent take-home incentives and C) non-contingent take-home in methadone maintenance in three groups of heroin-addicted patients attending three different MMT programmes. Retention rates at 12months were significantly higher in contingent take-home patients (group B) than in those with supervised daily consumption (group A) and the non-contingent take-home (group C). Retention rates were higher in group A than in group C patients. Compared to patients in groups A and B, those in group C showed fewer negative urinalyses and higher rates of self-reported diversion and episodes of crime or violence. Results indicate a more positive outcomes following take-home methadone associated with behavioural incentives and other measures that aim to facilitate treatment compliance than those following daily supervised consumption. By contrast, non-contingent take-home methadone given to non-stabilized patients is associated with a high rate of diversion, along with more crime episodes and maladaptive behaviours. ► Contingent take home incentive has the same retention rate than daily supervised administration. ► Noncontingent methadone treated patients showed the lowest retention rate. ► Contingent take home incentive groups and daily supervised groups have the same abstinence rate.