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Practice Profile

Methadone Maintenance Therapy

Evidence Ratings for Outcomes:

Effective - One Meta-Analysis Drugs & Substance Abuse - Heroin/opioids
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
No Effects - One Meta-Analysis Drugs & Substance Abuse - Mortality

Practice Description

Practice Goals/Target Population
Methadone maintenance treatment (MMT) is a medication-assisted treatment for individuals with opioid dependence. Methadone is a long-acting synthetic opioid analgesic that works as a pharmacologic intervention for patients in drug treatment and detoxification programs. MMT helps prevent or reverse withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body in order to reduce the illicit use of opioids.

Practice Components
Opioids, such as heroin or morphine, cause a release of excess dopamine in the body. Users become dependent on the drug because they need opiates to continuously occupy the opioid receptor in the brain. Methadone works by occupying this receptor and blocking the high that usually comes from illicit opioid drug use. This reduces the need and desire for users to seek and abuse opioids and diminishes the disruptive and uncontrolled behavior often associated with addiction. Subsequently, this allows patients to participate in normative activities, such as drug treatment programs or therapies.

Methadone can suppress narcotic withdrawal symptoms for 24 to 36 hours. Single oral doses are administered daily under observation at a licensed clinic. Dosage is determined by several factors related to the patient, such as opioid tolerance level, history of opioid use, age, and current medical status. Initial doses may start at around 20–30 milligrams (mg) per day and increase to 80–100 mg per day. The amount of time in MMT will also vary by patient. In general, MMT takes a minimum of 12 months, but some patients may require continuous treatment that lasts over several years.

MMT may be available in settings such as correctional facilities or community-based outpatient drug treatment facilities. In addition to administering medication, MMT may also involve providing patients with ancillary services such as behavioral therapies, outpatient rehabilitation, counseling, psychosocial services, medical services, and psychiatric care.

Meta-Analysis Outcomes

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Effective - One Meta-Analysis Drugs & Substance Abuse - Heroin/opioids
Examining the results from six studies, Mattick and colleagues (2009) found that participants in methadone maintenance therapy (MMT) were less likely to test positive for heroin use (as measured by morphine-positive urine or hair analysis), compared with individuals who did not participate in MMT (RR = 0.66). This difference was statistically significant.
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Based on the results from three studies, Mattick and colleagues (2009) found there was no statistically significant effect on measures of criminal activity (RR = 0.39).
No Effects - One Meta-Analysis Drugs & Substance Abuse - Mortality
Based on the results from four studies, Mattick and colleagues (2009) found there was no statistically significant effect on measures of mortality (RR = 0.48).
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11970 - 2008111969

Meta-Analysis 1
Mattick and colleagues (2009) conducted a meta-analysis to evaluate the effectiveness of methadone maintenance treatment (MMT) on opioid dependence. Interventions were included in the review if they used MMT, including those that employed other treatments such as behavioral therapies or outpatient rehabilitation. Only randomized controlled trials of MMT were included. All studies had to compare MMT with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. The authors conducted an electronic search, through December 2008, of several databases such as the Cochrane Central Register of Controlled Trials, PubMed, and Embase. Conference proceedings and reference lists of identified studies were reviewed, and authors of identified studies were asked about other published or non-published studies. The searches include non-English language literature (studies were translated if they met inclusion criteria).

A total of 11 studies were included in the review, which involved a total of 1,969 participants. All included studies were randomized controlled trials; two studies were placebo-controlled trials, and the remaining studies were not blinded. The duration of the studies varied, running from several weeks to 2 years. Three studies were conducted in a prison setting, and the other eight were conducted in medical or research facilities (such as outpatient hospital detoxification programs or community methadone treatment facilities). One study was conducted in Australia, one in Sweden, one in Hong Kong, and one in Thailand; the other seven studies were conducted in the United States. The age, gender, and race/ethnicity of participants varied by study. Most studies included only males or a majority of males. The average ages of participants ranged from 27 to 42 years. The race/ethnicity of participants in the U.S.-based studies included mostly white, black, and Hispanic participants, with a smaller percentage of Native Americans and Asian/Pacific Islanders.

The outcomes of interest included heroin use (measured as morphine-positive urine or hair analysis), criminal activity, and mortality. The relative risks (RR) and 95-percent confidence intervals were calculated for dichotomous outcomes, and a standardized mean difference was calculated for continuous outcomes. The data were analyzed using a random effects model.
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Cost

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There is no cost information available for this practice.
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Implementation Information

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Methadone maintenance treatment is a monitored and regulated medical treatment. Therefore, methadone, when used in the treatment of opioid addiction, can only be dispensed by a federally licensed opioid treatment program (OTP). OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA). For more information, please see SAMHSA’s website on Certification of OTPs: https://www.samhsa.gov/medication-assisted-treatment/opioid-treatment-programs
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Mattick, Richard P., Courtney Breen, Jo Kimber, and Marina Davoli. 2009. “Methadone Maintenance Therapy Versus No Opioid Replacement Therapy for Opioid Dependence.” Cochrane Database of Systematic Reviews (3):CD002209.
https://researchonline.lshtm.ac.uk/5044/
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Additional References

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These sources were used in the development of the practice profile:

Amato, Laura, Marina Davoli, Silvia Minozzi, Eliana Ferroni, Robert Ali, and Marica Ferri. 2013. “Methadone at Tapered Doses for the Management of Opioid Withdrawal.” Cochrane Database of Systematic Reviews (2): CD003409.

Bawor, Monica, Brittany B. Dennis, Anuja Bhalerao, Carolyn Plater, Andrew Worster, Michael Varenbut, Jeff Daiter, David C. Marsh, Dipika Desai, Meir Steinder, Rebecca Anglin, Guillaume Pare, Lehana Thabane, and Zainab Samaan. 2015. “Sex Differences in Outcomes of Methadone Maintenance Treatment for Opioid Use Disorder: A Systematic Review and Meta-Analysis.” CMAJ Open 3(3):E344–51.

Corsi, Karen F., Wayne K. Lehman, and Robert E. Booth. 2009. “The Effect of Methadone Maintenance on Positive Outcomes for Opiate Injection Drug Users.” Journal of Substance Abuse Treatment 37:120–26.

Farre, Magi, Anna Mas, Marta Torrens, Victor Moreno, and Jordi Cami. 2002. “Retention Rate and Illicit Opioid Use During Methadone Maintenance Interventions: A Meta-Analysis.” Drug and Alcohol Dependence 65:283–90.

Faggiano, Fabrizio, Federica Vigna-Taglianti, Elisabetta Versino, and Patrizia Lemma. 2003. “Methadone Maintenance at Different Dosages for Opioid Dependence.” Cochrane Database of Systematic Reviews (3):CD002208.

Fiellin, David A., Patrick G. O’Connor, Marek Chawarski, Juliana P. Pakes, Michael V. Pantalon, and Richard S. Schottenfeld. 2001. “Methadone Maintenance in Primary Care: A Randomized Controlled Trial.” Journal of the American Medical Association 286(14):1724–1731.

Gruber, Valerie A., Kevin L. Delucchi, Anousheh Kielstein, and Steven L. Batki. 2008. “A Randomized Trial of 6-Month Methadone Maintenance With Standard or Minimal Counseling Versus 21-Day Methadone Detoxification.” Drug and Alcohol Dependence 94:199–206.

Millson, Peggy, Laurel Challacombe, Paul J. Villeneuve, Carol J. Strike, Benedikt Fischer, Ted Myers, Ron Shore, and Shaun Hopkins. 2007. “Reduction in Injection-Related HIV Risk After 6 Months in a Low-Threshold Methadone Treatment Program.” AIDS Education and Prevention 19(2):124–36.

Sees, Karen L., Kevin L. Delucchi, Carmen Masson, Amy Rosen, H. Westley Clark, Helen Robillard, Peter Banys, and Sharon M. Hall. 2000. “Methadone Maintenance vs. 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial.” Journal of the American Medical Association 283(10):1303–1310.

Strain, Eric C., George E. Bigelow, Ira A. Liebson, and Maxine L. Stitzer. 1999. “Moderate- vs. High-Dose Methadone in the Treatment of Opioid Dependence: A Randomized Trial.” The Journal of the American Medical Association 281(11):1000–1005.

Washington State Institute for Public Policy. 2018. Methadone Maintenance for Opioid Use Disorder. Olympia, Wash.: Washington State Institute for Public Policy.
https://www.wsipp.wa.gov/BenefitCost/ProgramPdf/694/Methadone-maintenance-for-opioid-use-disorder
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Interim Methadone Maintenance (Baltimore, Md.) Promising - One study
This is a daily treatment program for opiate-addicted adults on waiting lists for comprehensive treatment who receive doses of methadone and emergency counseling. The program is rated Promising. Participants reported a statistically significant decrease in heroin use and had lower crime rates, compared with the waitlist control group. However, there was no statistically significant effect on cocaine use.

Prison-Initiated Methadone Maintenance Treatment Promising - One study
This program offers methadone maintenance to heroin-addicted prisoners and provides referrals to community-based treatment programs to encourage continued treatment during reentry. The program is rated Promising. The counseling + methadone group were significantly more likely to spend more days in treatment compared to the other groups. There were fewer positive urine drug tests for opioids and cocaine for the counseling + methadone group compared to those who received counseling only in prison.

New South Wales (Australia) Prison Methadone Maintenance Program No Effects - One study
This program aims to reduce recidivism, prevent the spread of blood-borne viral infections (HIV and hepatitis) in prison, and encourage continuation of treatment in the community following release. The program is rated No Effects. Overall, the evidence did not find a significant difference between the prison methadone maintenance treatment group and the control group on measures of mortality, reincarceration, hepatitis C virus seroconversion and treatment retention.
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Practice Snapshot

Age: 27 - 42

Gender: Both

Race/Ethnicity: Asian/Pacific Islander, Black, Hispanic, White

Targeted Population: Alcohol and Other Drug (AOD) Offenders, Prisoners

Settings: Correctional, Inpatient/Outpatient

Practice Type: Alcohol and Drug Therapy/Treatment, Cognitive Behavioral Treatment, Residential Treatment Center

Unit of Analysis: Persons