Practice Profile: Methadone Maintenance Therapy

Evidence Rating for Outcomes

Drugs & Substance Abuse | Heroin/opioids

Drugs & Substance Abuse | Mortality

Date: This profile was posted on October 28, 2019

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 Ineffective for reducing criminal activity and mortality.

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. The goals of MMT programs are to 1) improve the drug users’ quality of life, 2) diminish social costs of drug addiction, and 3) reduce drug-related offenses and other types of public order problems and increase public safety.

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 Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	1970-2008	11	1969
Meta Analysis 2	1970-2008	10	2109

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.

Meta Analysis 2

Egli and colleagues (2009) conducted a meta-analysis to evaluate the effects of drug prescription and substitution programs, including methadone maintenance treatment programs, on criminal behavior. Their comprehensive search included a keyword search of online abstracts, bibliographies, and literature databases (such as Campbell Crime and Justice Group (C2-SPECTR), National Criminal Justice Reference Service (NCJRS), MEDLINE, Harm Reduction Journal, Journal of Substance Abuse Treatment, National Treatment Agency for Substance Misuse (NHS), National Treatment Outcome Research Study (NTORS), Drug and Alcohol Dependence, and Drug and Alcohol Review).

Literature in any language, published after 1960, was eligible for inclusion in the meta-analysis. Studies related to any kinds of drugs were eligible, including drugs considered illegal according to international agreements and local (national) laws, such as heroin, morphine, opium, cocaine, crack, MDMA, amphetamines, LSD, ketamine, cannabis, fentanyl, and inhalants. However, only studies that met the following criteria were included: 1) randomized studies, quasi-experimental studies, and before-after comparisons that examined the effects of drug prescription and drug substitution programs on offending, which met level 4 or higher on the scale developed by Sherman and colleagues (1997); 2) interventions that were court-ordered or unrelated to any involvement with the criminal justice system; and 3) interventions based on substitution programs (e.g., methadone as a substitute for illegal drugs) rather than drug abstinence. Programs that did not include prescriptions for any treatment (e.g., psychotherapy, detoxification) or prescribed drugs such as tranquilizers or antibiotics were excluded. Studies that examined possible effects beyond offending (e.g., medical outcomes) were also not considered.

A total of 46 studies were identified; however, only 41 studies were eligible for inclusion in the meta-analysis. Of the 41 studies,10 studies (7 randomized controlled trials and 3 quasi-experimental designs) met level 4 or higher on the scale developed by Sherman and colleagues (1997) and were included in the meta-analysis. Study participants consisted of drug addicts, adults and adolescents, males and females. Of the 2,109 study participants included in the analysis, 1,025 were assigned to the treatment group and 1,084 to the control group. Control groups across these studies were assigned to wait-list, placebo, counseling, residential treatment, or detoxification groups. Program duration ranged from 2 months to 36 months.

Appropriate measures of the primary outcome for the review (criminal behavior) included offending, reconviction data, police records, and self-reported delinquency. Odds ratios and random and fixed effects models were calculated to measure program effects between the treatment and control groups.

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

Sherman, Lawrence W., Denise C. Gottfredson, Doris L. Mackenzie, John Eck, Peter Reuter, and Shawn Bushway. 1997. Preventing Crime: What Works, What Doesn’t, What’s Promising? A Report to the United States Congress. Washington, D.C.: U.S. Department of Justice, National Institute of Justice.

Date Created: July 17, 2024

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Practice Snapshot

Age: 27 - 42

Gender: Male, Female

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

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

Setting (Delivery): Inpatient/Outpatient, Correctional

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

Unit of Analysis: Persons

Practice Profile: Methadone Maintenance Therapy

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