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Methadone maintenance treatments at home can result in lower rate of hospitalizations

(RxWiki News) Among the treatments for dependence on opioids such as heroin or hydrocodone are methadone maintenance treatments, which block a person's cravings and relieve withdrawal symptoms.

Methadone does not cause the same "high" as heroin, oxycontin, morphine or other opioids, and it can be used long term, but it is generally dosed out at a treatment facility.

A recent study has found that patients who qualify to take their dosage home with them and take it unsupervised actually have lower rates of hospitalization than those not using take-home doses.

"If you have a drug addiction, seek help."

In a study led by Alexander Y. Walley, MD, MSc, of the Clinical Addiction Research and Education Unit at Boston Medical Center, researchers reviewed the daily electronic medical records of 138 patients enrolled in a methadone maintenance treatment program.

They looked at which patients had been given take-home doses of methadone, which patients received doses of 80 mg or more of methadone and hospital admission dates, if the patients were admitted to a hospital.

Their goal was to determine whether giving a patient a take-home dose or a dose of 80 mg or greater led to a hospital admission on the following day.

They adjusted their findings to account for age, gender, race/ethnicity, HIV status, medical or mental illness and any other substances the patents may have been using.

About a third of the patents had a medical illness in addition to their addiction, and 40 percent had a mental illness. In addition, 52 percent were dependent on other substances.

According to the study, "Take homes are the primary incentive methadone maintenance treatment programs use for positive reinforcement for patients who are succeeding in treatment and are granted after at least 90 days of complete methadone dosing attendance, counseling attendance, and no evidence of any illicit substances as determined by urine drug testing."

In this study, 52 percent of the patients had at least one documented take-home treatment dose during the study period's follow-up, which averaged 20 months. In addition, 75 percent had at least one dose of 80 mg or more.

Those who received take-home doses were less likely to be using other substances at the start of the study and had spent more months in treatment before the study began.

During the study period, 30 percent of the patients were frequently hospitalized: 80 hospital admissions total among the 42 patients.

Only nine of these hospitalizations were for an individual who had received a take-home dose for their treatment whereas 50 of these hospitalizations were for a patient whose dose had been at least 80 mg.

Unsurprisingly, those who had a separate medical illness were more likely to be hospitalized.

The researchers therefore concluded that take-home methadone maintenance treatment doses do not lead to a higher rate of hospitalization and may be a good practice for patients who qualify.

"Among methadone maintenance treatment patients, receipt of take homes, but not dose of methadone, was significantly associated with reduced medical hospitalizations," the authors wrote. "Thus, take-home status reflects not only patients’ improved addiction outcomes but also reduced health care utilization."

The researchers recommended further study and consideration for take-home doses of the treatment.

"Given that this characteristic is easy to measure, clinically important and had cost implications, it should be further considered as a useful quality and performance measure for methadone maintenance treatments," they wrote.

The study was published June 12 in the Journal of Addiction Medicine. The research was funded by the National Institute on Drug Abuse and was supported by the Opioid Treatment Program at the Boston Public Health Commission. The authors declared no conflicts of interest.

Review Date: 
July 8, 2012