Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings

Aims: This study aimed to determine the relative effectiveness of 12 months of interim methadone (IM; supervised methadone with emergency counseling only for the first 4 months of treatment), standard methadone treatment (SM; with routine counseling) and restored methadone treatment (RM: routine counseling with smaller case-loads).

Design: A randomized controlled trial was conducted comparing IM, SM and RM treatment. IM lasted for 4 months, after which participants were transferred to SM.

Setting: The study was conducted in two methadone treatment programs in Baltimore, MD, USA.

Participants: The study included 230 adult methadone patients newly admitted through waiting-lists.

Measurements: We administered the Addiction Severity Index and a supplemental questionnaire at baseline, 4 and 12 months post- baseline. Measurements included retention in treatment, self-reported days of heroin and cocaine use, criminal behavior and arrests and urine tests for heroin and cocaine metabolites.

Findings: At 12 months, on an intent-to-treat basis, there were no significant differences in retention in treatment among the IM, SM and RM groups (60.6%, 54.8% and 37.0%, respectively). Positive urine tests for the three groups declined significantly from baseline (Ps < 0.001 and 0.003, for heroin and cocaine metabolites, respectively) but there were no significant group x time interactions for these measures. At least one arrest was reported by 30.6% of the sample during the year, but there were no significant between-group effects.

Conclusions: Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin--at least for the first 4 months of treatment.