Interim Methadone with Limited Counseling for 4 Months Yields Similar 12-Month Outcomes as Methadone with Standard Counseling

Interim methadone (IM) provides 4 months of methadone and emergency-only counseling to opioid-dependent patients. This article reports 12-month results from a randomized clinical trial that previously found counseling intensity had no effect on outcomes at 4 months (see Alcohol, Other Drugs, and Health: Current Evidence, May-June 2011). Newly admitted participants (N=230) in 2 methadone programs in Baltimore, MD, were randomized to 1 of 3 conditions: IM for 4 months then transfer to standard methadone (SM), including routine counseling, for 8 months; 12 months of SM; or 12 months of restored methadone (RM), including routine counseling delivered by counselors with smaller caseloads.

• Treatment retention was similar between the IM (61%), SM (55%), and RM (37%) groups at 12 months in an intent-to-treat analysis.

• Positive urine-toxicology screens for opioids or cocaine declined from baseline for the entire sample, with no differences found between groups.

Comments:

At a minimum, this study suggests that, instead of being placed on a waitlist, opioid-dependent persons seeking methadone treatment should undergo methadone induction while waiting for a counseling opening. A more radical view, perhaps taken by administrators and policymakers seeking to introduce efficiencies into methadone treatment, is that standard counseling during the first few months does not appear to offer much over and above medication. That is not to say counseling is not useful; indeed, all patients in this study received standard counseling after the first 4 months. However, people whose opioid use is in early remission often have other pressing life concerns—housing, work, etc.—that loom larger on Maslow’s hierarchy of needs. Given some stability in their drug habit and a few months to address these concerns, it is possible they might become more ready to hear what counselors have to say.

Peter D. Friedmann, MD, MPH

Reference:

Schwartz RP, Kelly SM, O’Grady KE, et al. Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. Addiction. 2012;107(5):943–952.