Changes in Methadone Treatment Practices: Results From a National Panel
Study, 1988-2000
by Thomas D’Aunno, PhD; Harold A. Pollack, PhD
Journal of the American Medical Association Vol. 288, No. 7 August 21, 2002
Context Results from several studies conducted in the early 1990s
showed that the majority of US methadone maintenance programs did not
use treatment practices that met established standards for the care of
heroin users. Effective treatment for heroin users is critical given the
upsurge in heroin use and the continued role of injection drug use in
the human immunodeficiency virus and hepatitis C epidemics.
Objectives To examine the extent to which US methadone maintenance
treatment programs have made changes in the past 12 years to provide
adequate methadone doses and to identify factors associated with
variation in program performance.
Design, Setting, and Participants Program directors and clinical
supervisors of nationally representative methadone treatment programs
that varied by ownership (for-profit, public, or private not-for-profit)
and setting (eg, free-standing, hospital-based) were surveyed in 1988 (n
= 172), 1990 (n = 140), 1995 (n = 116), and 2000 (n = 150).
Main Outcome Measures Percentage of patients in each treatment program
receiving methadone dosages of less than 40, 60, and 80 mg/d.
Results The percentage of patients receiving methadone dosage levels
less than the recommended 60 mg/d has decreased from 79.5% in 1988 to
35.5% in 2000. Results also show that programs with a greater percentage
of African American patients are especially likely to dispense low
dosages, while programs with Joint Commission on Accreditation of
Healthcare Organizations accreditation are more likely to provide
adequate methadone doses.
Conclusions Efforts to improve methadone treatment practices appear to
be making progress, but many patients are still receiving substandard
care.
JAMA. 2002;288:850-856
Author Affiliations: School of Social Service Administration and Department of Health Studies, University of Chicago (Dr D’Aunno), and Department of Health Management and Policy, School of Public Health (Dr Pollack), University of Michigan, Ann Arbor. Dr D’Aunno is now with INSEAD, Fontainebleau, France.
Corresponding Author and Reprints: Thomas D’Aunno, PhD, INSEAD, Boulevard de Constance, 77305 Fontainebleau Cedex, France (e-mail: [email protected]).
Copyright 2003 January 19, 2003