Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling
No controlled studies have compared short-term methadone maintenance (MM) to methadone detoxification (MD), although it is known that open-ended MM is more effective than MD. Gruber et al. took advantage of a randomized controlled trial (RCT) assessing the effect of 6-month MM on adherence to latent tuberculosis therapy to compare 21-day MD to 6-month MM with either minimal or standard counseling.
In this RCT (n=111), outcomes were substance use and depressive symptoms. Doses of methadone were between 60 and 90 mg per day. Minimal counseling involved a single 15-minute session per month with no contingencies (e.g., take-home medication). Standard counseling involved 2 sessions per month (more, if needed, as determined by the counselor) with the opportunity to earn take-home medications. The majority of subjects were male, nonwhite, poor, and not interested in stopping heroin but rather in cutting down on use.
- Compared with 6-week MD, 6-month MM resulted in a greater decrease from baseline in self-reported opiate use, opiate positive urines, and days of alcohol use.
- No difference between groups was found for cocaine use or depressive symptoms.
- Results for MM with standard counseling did not differ from those for MM with minimal counseling.
Comments:These findings show once again that the duration of time on methadone therapy is key to the benefits received, mainly with regard to opiate-related outcomes. As the treatment groups were quite small, few conclusions can be drawn concerning the lack of differences noted between counseling intensity in the 6-month MM groups. Jeffrey H. Samet, MD, MA, MPH
Gruber VA, Delucchi KL, Kielstein A, et al. A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug Alcohol Depend. 2008;94(1–3):199–206.