Methadone Maintenance Therapy Decreases Arrests

Previous observational reports of methadone maintenance therapy (MMT) suggest that MMT reduces criminal activity. Treatment with methadone often includes medication and counseling; interim methadone (IM) provides medication alone in an effort to reduce costs. In this clinical trial, investigators randomized patients awaiting entry into a comprehensive MMT program to receive either IM (n=198) or to a waiting list (n=119). Interim methadone, providing no counseling, was offered for up to 120 days. After controlling for potential confounders, investigators compared retention in treatment among patients in both groups at 6 and 12 months.

• Patients assigned to IM had significantly fewer arrests at 6 months compared with waiting list patients (mean, 0.20 versus 0.34).

• There was no difference in arrest severity between groups at 6 or 12 months; however, there were significantly fewer arrests at 6 and 12 months among patients in continuous treatment compared with patients not in continuous treatment (mean, 0.14 versus 0.29 at 6 months and 0.18 versus 0.40 at 12 months, respectively).

• More patients in the IM group were retained in treatment compared with waiting list patients (65% versus 25%).

Comments:

In this randomized clinical trial, patients in the IM arm had fewer arrests and were more likely to be retained in treatment compared with waiting list patients. The policy implication of this study is important in that IM may provide additional benefits (i.e., reduction in criminal activity and retention in treatment) beyond the morbidity and mortality benefits conferred by comprehensive MMT. Hillary Kunins, MD, MPH, MS

Reference:

Schwartz RP, Jaffe JH, O'Grady KE, et al. Interim methadone treatment: impact on arrests. Drug Alcohol Depend. 2009;103(3):148–154.