For about 30 years in the US, certified clinics have used methadone maintenance to help heroin users stay off the drug. Patients have traditionally had to make frequent clinic visits to get the medication.
Starting in May 2001, US regulations allowed clinics to offer take-home methadone doses of up to 1 month–although some state laws still do not.
«Many clinics are starting to dispense monthly take-homes to highly stable patients,» Dr. Van L. King of Johns Hopkins University in Baltimore, Maryland, told Reuters Health.
Still, many other methadone clinics are hesitant to start such programs, according to Dr. King, who led the new study. There are concerns that allowing people on methadone to take home substantial amounts could lead to misuse–such as patients taking dangerously high doses or dispensing the drug to others.
But others argue that it is too restrictive to require long-abstinent patients to visit a methadone clinic every week to get their medication. Dr. King said it is important to allow «well-rehabilitated» patients to spend as much time as possible with family and at work.
In their study, Dr. King and colleagues compared monthly methadone «take-homes» with standard therapy among 78 patients at two Baltimore clinics. All had been on methadone without heroin relapses for at least 1 year and had full-time jobs.
Patients were randomly assigned to one of three groups: routine treatment with two or three clinic visits per week; at-home treatment with a 28-day supply of methadone from the clinic; or at-home treatment with a 28-day supply from a doctors office.
To help ensure compliance, those who got the months supply of methadone had to occasionally bring their unused medication to the clinic or office to be counted. Throughout the study, all patients provided urine samples to monitor their drug use, and all had monthly counseling sessions.
In addition, anyone who failed a urine test or had problems with their medication compliance had a short-term «intensification» in their monitoring and counseling.
After 6 months, there had been relatively few problems with methadone compliance, with no differences among the three groups, Dr. Kings team reports in the January issue of the journal Drug and Alcohol Dependence. Only about 1% of urine samples were positive for drugs.
Patients who got the 28-day doses «continued to do extremely well in treatment despite a dramatic reduction in the intensity of their care,» the researchers write.
Dr. King stressed, however, that only methadone-treated patients with long-standing abstinence from illicit drugs–and preferably with jobs and strong social support–are good candidates for this type of treatment.
In addition, he said, clinics that offer month-long doses will be more successful if they use the comprehensive monitoring and counseling his team did. He and his colleagues are starting a project to help other Baltimore clinics develop similar programs.
