Methadone maintenance found to be more effective in treating heroin addiction than 180 day detoxific

Methadone maintenance is more effective in reducing heroin use among addicts
than a 180 -day detoxification program that included an array of counseling
services, a UC San Francisco study has found.

The objective of the study was to compare methadone maintenance-a widely used
but controversial method of weaning heroin addicts off the drug—with an
alternative treatment of psychosocially enriched 180 day methadone assisted
detoxification. Methadone maintenance resulted in lower heroin use rates and
fewer drug- related HIV risk behaviors, such as sharing needles. The study
results will be published in the March 8 issue of the Journal of the American
Medical Association.

“Methadone maintenance is controversial,” said Sharon Hall, PhD, lead author of
the study and UCSF professor in residence and vice-chair of psychiatry. “People
don’t like it because it is continued provision of an addicting drug. When
people come on methadone maintenance, they may stay on it for several years.
The idea of the study was to do a comparison to find a method that was as
effective but didn’t involve indefinite treatment with an addicting drug.”

Methadone maintenance has been used to treat heroin addiction since 1964, Hall
said. Heroin is a short- acting opiate, Hall explained, meaning it produces a
high and a withdrawal effect rapidly. Methadone is a slower acting—and
legal—opiate. It works by stabilizing heroin users so that they do not have a
heroin -induced euphoria or suffer from severe withdrawal symptoms.

The study enrolled 179 participants who were assessed monthly for a year. A
urine specimen was collected each time.

Those in the methadone maintenance part of the study received stable doses of
methadone. Participants also attended one hour per week of substance abuse
group therapy for the first six months and one hour per month of individual
therapy. 

Those in the 180 -day detoxification program received 120 days of methadone
treatment, followed by 60 days of methadone dose reduction until they were no
longer taking methadone. They also received a host of drug counseling services.
During the first six months, participants were required to attend two hours per
week of substance abuse group therapy, one hour per week of cocaine group
therapy if they were found to also be addicted to that drug, and a series of
one- hour substance abuse education classes held weekly. They also attended
weekly individual therapy sessions. During the last seven months of the study,
participants were offered aftercare treatment that included weekly individual
and group psychotherapy and liaison services with the criminal justice system,
medical clinics and social service agencies.

Methadone maintenance was found to retain more patients and be more effective
in decreasing heroin use, though use was still high in both groups. Also, the
study found that those addicted to cocaine were more likely to drop out of the
180-day program than the methadone maintenance program.

“I think the results came out the way they did because heroin is a very
addicting drug and we need pharmacological tools at this point to fight that
addiction,” Hall said. “It’s not enough to just provide psychosocial services
when we lose methadone. There are two ways the field could change. One is to
develop more sophisticated pharmacological treatments for heroin addiction that
have less addiction potential. Another thing we need to think about is
developing psychosocial interventions targeting what methadone patients need
like legal and vocational services.”

Hall added that one of the reasons the counseling services offered as part of
the 180- day detoxification program did not lower heroin use might be because
they were too general.

“The other thing this study points out is that a long time ago methadone
maintenance clinics had many more services than they do now,” she said. “And
perhaps that’s one of the reasons the 180 day detoxification didn’t work. The
services were limited in scope. We didn’t have legal or vocational services or
family therapy. Many methadone programs have lost funding for these types of
services and we have yet to see what a methadone program looks like that has
them.”

A National Institute on Drug Abuse grant funded this study.

Other authors of the study are: Karen Sees, DO, UCSF assistant clinical
professor of psychiatry; Kevin Delucchi, PhD, UCSF assistant professor of
psychiatry; Carmen Masson, PhD, UCSF adjunct professor of psychiatry; Amy
Rosen, PsyD, UCSF research coordinator; H. Westley Clark, MD, MPH, on leave
from position as UCSF associate clinical professor of psychiatry; Helen
Robillard, RN, MSN, MA, research nurse practitioner at the Veteran Affairs
Medical Center in San Francisco; Peter Banys, MD, associate clinical professor
and vice chair, psychiatry at the Veteran Affairs Medical Center in San
Francisco.