What The Future Holds

Methadone maintenance has demonstrated its effectiveness in reducing illicit drug use and facilitating the transition to a productive lifestyle. In the mid to late 1990s, two major scientific bodies reviewed the evidence on methadone maintenance and concluded it was an effective modality whose usefulness was greatly reduced by stigma and over regulation (National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998; Rettig & Yarmolinsky, 1995). The documents produced by these groups have been instrumental in efforts around the country to reduce barriers and make the delivery system more flexible and responsive to patient needs.

Research including long-term followup indicates that stabilized and socially responsible methadone patients can be safely given a month of take-home medication by physicians in an office-based practice (Novick & Joseph, 1991; Novick et al., 1994). The federal government is in the process of formulating guidelines and regulations to permit treatment to occur in the office of a physician affiliated with a methadone clinic. For the patient, this represents a significant opportunity to shift from the traditional treatment system, segregated from the rest of medical practice since the 1960s, to the mainstream medical system. Although these changes are likely to be implemented most easily with stabilized methadone patients, pilot programs are underway to admit new patients (such as those in rural areas) to an office-based practice. Concurrently, the development of an accreditation mechanism is intended to simplify regulations and emphasize clinical practice guidelines that are more easily modified in response to emerging research findings. These activities will likely reduce barriers to treatment and allow for the development of less restrictive treatment settings.

Other maintenance pharmacotherapies, particularly LAAM and buprenorphine, have been developed and will broaden the options and possibilities for effective intervention. Federally sponsored training efforts have improved the quality of care and will continue to be essential to disseminating current information and providing opportunities for skill development. Slowly, patients have emerged as visible examples of success and to serve as role models for others. Barriers to participation in residential treatment are beginning to be removed. It is hoped that developments will engender future gains and allow this modality to gain the acceptance it so greatly deserves.

BIBLIOGRAPHY

Ball, J. & Ross, A. (1991). The effectiveness of methadone maintenance: Patients, programs, services, and outcomes. New York: Springer-Verlag.

BATKI, S. (1988). Treatment of intravenous drug users with AIDS: the role of methadone maintenance. Journal of Psychoactive Drugs, 29, 214-226.

CAPLEHORN, J. R. M. & Bell, J. (1991). Methadone dosage and retention of patients in methadone treatment. The Medical Journal of Australia, 1.54, 195-199.

D'AUNNO, T. & VAUGHAN, T. E. (1992). Variations in methadone treatment practices result from a national study. Journal of the American Medical Association, 267(2), 253-258.

DOLE, V. (1988). Implication of methadone maintenance for theories of narcotic addicition. Journal of the American Medical Association, 260, 3025-3029.

FlNNEGAN, L. (1991). Treatment issues for opioid-de-pendent women during the perinatal period. Journal of Psychoactive Drugs, 23 (2), 191-201.

Government Accounting Office. (1990). Methadone maintenance. Washington D.C., General Accounting Office.

Hartel, D., Selwyn, P. A., Schoenbaum, E. E., Klein, R. S., & FRIEDLAND, G. H. (1988). Methadone maintenance treatment and reduced risk of AIDS and AIDS-specific mortality in intravenous drug users. Paper presented at the 4th International Conference on AIDS, June 1988: Stockholm, Sweden.

Jarvis, M., & Schnoll, S. (1994). Methadone treatment during pregnancy. Journal of Psychoactive Drugs, 26 (2).

McLellan, A. T., Arndt, I. O., Metzger, D. S., Woody, G. E., O'BRIEN, C. P. (1993). The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association, 269(15), 19531996.

McLellan, A. T. (1983). Patient characteristics associated with outcome. In Cooper, J. R., Altman, F., Brown, B.S. et al. (Eds). Research on the treatment of narcotic addiction: State of the art, 19-79. Rockville, MD: U.S. Department of Health and Human Services.

National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. (1998). Effective medical treatment of opiate addiction. Journal of the American Medical Association, 280 (22), 1936-1943.

Novick, D. M., & Joseph, H. (1991). The treatment of chronic opiate dependence in general medical practice. Journal of Substance Abuse Treatment, 8, 233239.

Novick, D. M., Salsitz, E. A., Kalin, M. F., Keefe, J. B., Miller, E. L., & Richman, B. L. (1994). Outcomes of treatment of socially rehabilitated methadone maintenance patients in physician's offices (medical mainte-

nance): Follow-up at three and a half to nine and a fourth years. Journal of General Internal Medicine, 9, 127-130.

Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Journal of the American Medical Association, 264 (19), 2511-2518.

RETTIG, R. A., & YARMOLINSKY, A. (1995). Federal regulation of methadone treatment. Washington, D.C.: National Academy Press

Woody, G. E., McLellan, A. T., Lubursky, L, O'Brien, C. P. (1986). Psychotherapy for substance abuse. Psychiatric Clinics of North America, 9 (3), 547-562.

Woody, G. E., Luborsky, L., McLellan, A. T., et al. (1983). Psychotherapy for opiate addicts: Does it help? Archives of General Psychiatry, 40, 639-645.

ZWEBEN, J. E. (1991). Counseling issues in methadone maintenance treatment. Journal of Psychoactive Drugs, 23 (2), 177-190.

Dealing With Drugs

Dealing With Drugs

Get All The Support And Guidance You Need To Be A Success At Dealing With Drugs. This Book Is One Of The Most Valuable Resources In The World When It Comes To A Parents Guide To The Drug Talk.

Get My Free Ebook


Post a comment