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Program Profile: Interim Methadone Maintenance (Baltimore, Md.)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 10, 2011

Program Summary

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.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Services Provided
Interim Methadone Maintenance (IM) is a substance abuse treatment approach that serves as a transition for patients who are waiting to be placed in a comprehensive methadone treatment program (MTP).

IM works by providing a safe way to engage clients, curb opiate craving, and prevent opiate withdrawal symptoms. Such interim programs provide physical examinations and education about HIV prevention, but do not provide the full range of counseling and social services of MTPs, making them less expensive than MTPs. The goals of IM programs are to encourage patients to enroll in MTPs, reduce drug use, and reduce crime resulting from the need to satisfy opiate addiction.

Target Population/Eligibility
IM programs were started—and continue to exist—because of the extremely long waiting periods for treatment, inadequate funding, and regulations that increase the costs associated with MTPs. MTPs have consistently demonstrated their effectiveness in academic and medical research; however, treatment capacity remains inadequate, resulting in long waiting lists. Starting in 1993, U.S. Federal regulations allowed daily doses of methadone under direct supervision and emergency counseling for up to 120 days to patients on waiting lists for MTPs.

Evaluation Outcomes

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Study 1
Drug Use
Schwartz and colleagues (2007) reported that participants receiving Interim Methadone Maintenance (IM) had lower ASI Drug Use composite scores, compared with the control group, at the 6-month follow up. This difference was statistically significant.

Heroin Use
At the 6-month follow up, the treatment group reported using heroin for a mean of about 4 days, whereas the waitlist control group reported using heroin for about 26 days. Additionally, 48.1 percent of treatment group participants showed positive results for heroin, compared with 72.3 percent of the waitlist control group. Both differences were statistically significant.

Cocaine Use
There were no significant differences between treatment and control group participants in terms of self-reported cocaine use or of test results at the 6-month follow up.

At the 6-month follow up, participants receiving IM spent fewer days taking part in illegal activities than the control group (7 days and 2 days, respectively). This difference was statistically significant.
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Evaluation Methodology

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Study 1
Schwartz and colleagues (2007) used an experimental design to evaluate the effectiveness of Interim Methadone Maintenance (IM). The study was conducted in Baltimore, Md., a city with a large population of heroin addicts. Study participants were drawn from waiting lists for comprehensive methadone treatment programs (MTPs). Individuals were excluded from the study if they were pregnant or if they had an acute physical or mental illness. Participants were then randomly assigned to treatment and control groups.

This selection process resulted in 319 (199 treatment and 120 control) participants. The sample was 59.2 percent male, and primarily African American (93 percent), single (80.3 percent), and unemployed (62.1 percent). The treatment and control groups did not significantly differ from each other. The mean age of first-time heroin use was about 23; the mean age of first crime was about 21. Participants reported spending a mean of $876 on drugs in the 30 days prior to the experiment and obtaining about half of that amount, $462, as illegal income. Participants in the treatment group received an average dose of 78.4 mg, but daily doses were tailored to each individual’s needs, so some individuals received higher doses and others received lower doses.

In addition to the daily methadone medication, the treatment group received free condoms and information about HIV and AIDS. The control group received no methadone medication, only the condoms and information about disease. Emergency counseling was available to all participants; however, only three total participants used these services.

Outcomes measured included entry into an MTP, level of drug use, and crime rate. Urinalysis and the Addiction Severity Index (or ASI) were used to determine heroin and cocaine use. A baseline measurement was taken, with another measurement taken at 4 months or when the participant enrolled in an MTP, whichever came first. Participants were finally assessed 6 months later. Participants were paid $15 for the baseline measure and $25 for the follow-up measure. Univariate analyses (chi-square and t tests) and multiple logistic regressions were used to analyze the effectiveness of IM programs.
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There is no cost information available for this program.
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Implementation Information

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An intervention manual, which gives an overview and basic steps for implementation, is provided by the developer, and the developer is able to answer any questions by phone or email.

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Evidence-Base (Studies Reviewed)

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

Study 1

Schwartz, Robert P., Jerome Jaffe, D.A. Highfield, J.M. Callaman, and Kevin E. O’Grady. 2007. “A Randomized Controlled Trial of Interim Methadone Maintenance: 10-Month Follow-Up.” Drug and Alcohol Dependence 86(1):30–36.

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Additional References

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

Gryczynski, Jan, Robert P. Schwartz, Kevin O’Grady, and Jerome H. Jaffe. 2009. “Dropout From Interim Methadone and Subsequent Comprehensive Methadone Maintenance.” American Journal of Drug & Alcohol Abuse 35:394–98.

Gryczynski, Jan, Robert P. Schwartz, Kevin O’Grady, and Jerome H. Jaffe. 2009. “Treatment Entry Among Individuals on a Waiting List for Methadone Maintenance.” American Journal of Drug & Alcohol Abuse 35(5):290–94.

Schwartz, Robert P., David A. Highfield, Jerome Jaffe, Joseph V. Brady, C.B. Butler, C.O. Rouse, J.M. Callaman, Kevin E. O’Grady, and Robert Battjes. 2006. “A Randomized Controlled Trial of Interim Methadone Maintenance.” Archives of General Psychiatry 63(1):102–09.

Schwartz, Robert P., Jerome H. Jaffe, Kevin E. O'Grady, Babita Das, David A. Highfield, and Monique Wilson. 2009 “Scaling Up Interim Methadone Maintenance: Treatment for 1,000 Heroin-Addicted Individuals.” Journal of Substance Abuse Treatment 17:362–67.

Schwartz, Robert P., Jerome H. Jaffe, Kevin E. O’Grady, Timothy W. Kinlock, Michael S. Gordon, Sharon M. Kelly, Monique E. Wilson, and  Ashraf Ahmed. 2009. “Interim Methadone Treatment: Impact on Arrests.” Drug and Alcohol Dependence 103:148–54.

Schwartz, Robert P., Sharon M. Kelly, Kevin E. O'Grady, Devang Gandhi, and Jerome H.  Jaffe. In Press. “Interim Methadone Treatment Compared to Standard Methadone Treatment: 4-Month Findings.” Journal of Substance Abuse Treatment.

Yancovitz, Stanley, Don Des Jarlais, N.P. Peyser, E. Drew, P. Friedman, H.L. Trigg, and J.W. Robinson. 1991. “A Randomized Trial of an Interim Methadone Maintenance Clinic.” American Journal of Public Health 81(9):1185–91. 

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Related Practices

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Following are practices that are related to this program:

Opiate Maintenance Therapy for Dual Heroin–Cocaine Abusers
A medication-assisted treatment for opioid dependence, including methadone, buprenorphine, and Levo-Alpha-Acetymethadol (LAAM). The overall goals are to help opioid-addicted patients alleviate withdrawal symptoms, reduce or suppress opiate cravings, and reduce the illicit use of opioids (such as heroin). The practice is rated Effective for achieving higher sustained heroin abstinence for dual heroin–cocaine abusers, but No Effects for cocaine abstinence for dual abusers.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Drugs & Substance Abuse - Heroin/opioids
No Effects - One Meta-Analysis Drugs & Substance Abuse - Cocaine/crack cocaine

Methadone Maintenance Therapy
This practice involves a medication-assisted treatment for individuals with opioid dependence. Methadone is a long-acting synthetic opioid analgesic that works as a pharmacologic intervention to 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. The practice is rated Effective for reducing use of heroin/opioids but rated No Effects for reducing criminal activity and mortality.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Drugs & Substance Abuse - Heroin/opioids
No Effects - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
No Effects - One Meta-Analysis Drugs & Substance Abuse - Mortality
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Program Snapshot

Age: 26 - 55

Gender: Both

Race/Ethnicity: Black, Hispanic, White

Geography: Urban

Setting (Delivery): Inpatient/Outpatient

Program Type: Alcohol and Drug Therapy/Treatment

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active

Listed by Other Directories: National Registry of Evidence-based Programs and Practices

Robert Schwartz
Medical Director and Senior Research Scientist
Friends Research Institute, Inc.
1040 Park Avenue, Suite 103
Baltimore MD 21201
Phone: 410.837.3977
Fax: 410.752.4218