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Sees KL, Delucchi KL, Masson C, et al. Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial. JAMA. 2000;283(10):1303–1310. doi:10.1001/jama.283.10.1303
Author Affiliations: Department of Psychiatry, University of California, San Francisco (Drs Sees, Delucchi, Masson, Rosen, Clark, Banys, and Hall and Ms Robillard), and San Francisco Veterans Affairs Medical Center (Drs Sees and Banys).
Context Despite evidence that methadone maintenance treatment (MMT) is effective
for opioid dependence, it remains a controversial therapy because of its indefinite
provision of a dependence-producing medication.
Objective To compare outcomes of patients with opioid dependence treated with
MMT vs an alternative treatment, psychosocially enriched 180-day methadone-assisted
Design Randomized controlled trial conducted from May 1995 to April 1999.
Setting Research clinic in an established drug treatment service.
Patients Of 858 volunteers screened, 179 adults with diagnosed opioid dependence
were randomized into the study; 154 completed 12 weeks of follow-up.
Interventions Patients were randomized to MMT (n = 91), which required 2 hours of
psychosocial therapy per week during the first 6 months; or detoxification
(n = 88), which required 3 hours of psychosocial therapy per week, 14 education
sessions, and 1 hour of cocaine group therapy, if appropriate, for 6 months,
and 6 months of (nonmethadone) aftercare services.
Main Outcome Measures Treatment retention, heroin and cocaine abstinence (by self-report and
monthly urinalysis), human immunodeficiency virus (HIV) risk behaviors (Risk
of AIDS Behavior scale score), and function in 5 problem areas: employment,
family, psychiatric, legal, and alcohol use (Addiction Severity Index), compared
by intervention group.
Results Methadone maintenance therapy resulted in greater treatment retention
(median, 438.5 vs 174.0 days) and lower heroin use rates than did detoxification.
Cocaine use was more closely related to study dropout in detoxification than
in MMT. Methadone maintenance therapy resulted in a lower rate of drug-related
(mean [SD] at 12 months, 2.17 [3.88] vs 3.73 [6.86]) but not sex-related HIV
risk behaviors and in a lower severity score for legal status (mean [SD] at
12 months, 0.05 [0.13] vs 0.13 [0.19]). There were no differences between
groups in employment or family functioning or alcohol use. In both groups,
monthly heroin use rates were 50% or greater, but days of use per month dropped
markedly from baseline.
Conclusions Our results confirm the usefulness of MMT in reducing heroin use and
HIV risk behaviors. Illicit opioid use continued in both groups, but frequency
was reduced. Results do not provide support for diverting resources from MMT
into long-term detoxification.
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