Program Quality Effects on Patient Outcomes during Methadone Maintenance: A Study of 17 Clinics

This study was designed to replicate Ball and Ross's benchmark research, which was the first to identify a set of program quality factors for methadone maintenance programs and relate them to patient outcomes. Ball and Ross's treatment domain variables were measured in a new and larger sample of methadone clinics, and eight candidate program quality factors were derived. Both studies found that program factors defined by more frequent counseling contacts, higher director involvement with treatment. and more director experience were associated with lower drug use by patients during treatment. Several patient and counselor characteristics also were associated with drug-use outcomes.     

The Use of Urine Toxicology to Enhance Patient Control of Take-Home Doses in Methadone Maintenance: Effects on Reducing Illicit Drug Use

The present study sought to compare, in a pre-post (AB) design, the efficacy of 2 contingency management programs utilizing take-home doses as reinforcers of abstinence for methadone maintenance patients. The baseline schedule (A) imposed more restrictions on availability of take-home doses than did the experimental schedule (B) which provided take-home doses for any patients who supplied negative urine toxicology specimens. Weekly urine toxicology profiles of patients (n = 96) were examined for 16 weeks under the baseline schedule and for 16 weeks during the experimental schedule. Mean number of consecutive weeks of negative specimens was 11.51 (sd = 4.68) during the baseline period and increased to 12.55 (sd = 4.44) during the experimental period 0 = 2.39, df=95, p <. 02). For subjects who could be expected to improve (i.e. those positive during the baseline period, n = 54, 56.3 %) percentage of total positive urines declined from the baseline (mean = 22.6 %, SD = 20.3) to the experimental period (mean = 17.0 %, SD = 19.9; p <. 008, Wilcoxon Signed Ranks Test). These results support the idea that take-home doses serve as reinforcers of abstinence among methadone patients and that fewer restrictions on their availability make them even more effective.     

Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine

Background: Entry into methadone maintenance is associated with a reduction in criminal activity; less is known about the effects of office-based buprenorphine. Objective: To compare criminal charges before and after enrollment in methadone maintenance or office-based buprenorphine. Methods: Subjects were opioid-dependent adults who initiated either methadone maintenance (n = 252) or office-based buprenorphine (n = 252) between 2003 and 2007. Medical records were reviewed to gather demographic data and a state-maintained web-based database to collect data on criminal charges. Overall charges and drug charges in the 2 years prior to and after treatment enrollment were compared. Multivariable analysis was used to examine risk factors for charges after treatment enrollment. Results: In the 2 years after enrolling in treatment, subjects receiving methadone had a significant decline in the proportion of subjects with any charges (49.6% vs. 32.5%, p < .001) or drug charges (25.0% vs. 17.5%, p = .015), as well as the mean number of cases (0.97 vs. 0.63, p = .002) and drug cases (0.38 vs. 0.23, p = .008), while those who initiated buprenorphine did not have significant changes in any of these measures. On multivariable analysis, the strongest predictor of criminal charges in the 2 years after treatment enrollment was prior charges (adjusted odds ratio 3.35, 95% confidence interval, 2.24–5.01). Conclusions: Enrollment in office-based buprenorphine treatment did not appear to have the same beneficial effect on subsequent criminal charges as methadone maintenance. If this observation is replicated in other settings, it may have implications for matching individuals to these treatment options.     

A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization

Background

Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals.

Objectives

To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA).

Data sources

Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined.

Review methods

Selection criteria included: (1) AUD and adherence (N = 20); (2) AUD and health services utilization (N = 11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N = 10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV− status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized.

Data synthesis and conclusions

Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.