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NIDA Research on Methadone Treatment

Editor's Note: Through its research grant program, the National Institute on Drug Abuse (NIDA) currently funds a number of projects aimed at expanding our knowledge of effective methadone treatment. Some of the most interesting findings of these NIDA projects are summarized below.

Reducing the spread of AIDS. Dr. Charles O'Brien and his group at the University of Pennsylvania are finding that methadone treatment can reduce the spread of AIDS in chronic intravenous drug abusers. They have compared patients in methadone treatment to out-of-treatment subjects with a history of regular intravenous opiate use. Preliminary data analysis indicates that the out-of-treatment sample had higher initial seropositivity rates and higher seropositivity conversion rates during the 12-month course of the study. Despite knowledge of how HIV is transmitted, many drug abusers nevertheless continue to engage in high-risk behavior.

Comparing dosage levels. In view of the fact that many methadone programs are still committed to low-dose regimens, Dr. Maxine Stitzer and colleagues at Johns Hopkins University are investigating the relative efficacies of 50 mg, 20 mg, and methadone-free treatment in 212 opiate addicts enrolled in a 182-day, short-term program. Preliminary findings show that treatment retention was directly related to the size of methadone dose. For the group of patients who have stayed through the twentieth week of treatment, urines testing positive for opiates were lowest for the 50 mg group, intermediate for the 20 mg group, and highest for the methadone-free group. The 50 mg group showed a trend towards a lower percentage of cocaine-positive urines and had significantly fewer urines that were simultaneously positive for both cocaine and opiates.

Contribution of adjunctive therapy.There is substantial debate about whether methadone should be given alone or as part of a larger psychosocial treatment program. NIDA's major "methadone levels" project at the University of Pennsylvania is studying the contribution of adjunctive and social adjustment therapy. Preliminary results show that the addition of family therapy and basic skills instruction can significantly augment methadone treatment. The overall impression at this point is that outcome improves proportionally with the addition of high-quality adjunctive treatment; the higher the "level," the better the clinical result. For more information on this study, see Recent Research Indicates Counseling and Other Services Significantly Improve Outcomes for Methadone Patients

Treatment efficacy with naltrexone. There is now further evidence to support naltrexone as a safe and effective treatment for opiate dependence in highly motivated patients, particularly those who face sanctions for relapse. As part of its overall goal to increase the appropriate use of this agent, NIDA is supporting a randomized clinical trial of naltrexone therapy in Federal probationers who face incarceration for relapse to opiate dependence. This therapy is strikingly effective, with urine screens running less than 10 percent positive for opiates.

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