Exploring the effectiveness of methadone treatment from the perspective of drug users and their families: a qualitative study in Iran

ABSTRACT

The aim of this study was to explore the effectiveness of Methadone Maintenance Treatment (MMT) from the perspective of drug users and their families. For this qualitative content analysis study, 15 participants were selected via purposive sampling. Data collection was done using deep and semi-structured interviews, which were then analyzed. The results showed that MMT can bring favorable impacts into the patients’ lives and help them with the process of treatment and rehabilitation despite the medical side effects.     

The effect of alternative staff time data collection methods on drug treatment service cost estimates

Although a limited number of service cost estimates exist, no study has evaluated how differences in the method used to collect the staff time allocation across treatment services contribute to differences in service cost estimates. Three alternative data collection methods for estimating service-level costs in methadone treatment programs were evaluated: key informants, staff surveys, and staff diaries. We analyzed data from 25 methadone clinics across the United States. Results indicate that for the three primary services offered at methadone clinics—individual counseling, group counseling, and methadone dosing—no statistically significant differences exist in the mean estimates of costs per session across programs. Of the other five services analyzed, we found no statistically significant differences in two of the mean costs per session and a small but statistically significant difference in another service. We found large and statistically significant differences in mean costs for two services, initial patient assessment and initial medical services. Although there is no gold standard available to judge which method is the best to use, we concluded that the key informant method yields more reliable cost estimates compared with the staff methods and is less burdensome to both the treatment programs and to researchers. Our findings suggest that the key informant method is the preferred method for costing substance abuse treatment services.     

Methadone and Menopause: Midlife Women in Drug Treatment

ABSTRACT

As a rising number of midlife women receive methadone treatment, issues related to the menopausal transition take on increased importance. The similarity between many of the symptoms associated with opiate withdrawal, methadone and menopause (hot and cold flashes, sweats, fatigue, decreased libido, menstrual irregularity and insomnia), make it plausible these women and clinical staff attribute menopausal symptoms to other conditions of greater familiarity. The paucity of research, multiplicity of health problems and typically poor access to health care, further complicate the picture and underscore the importance of better integration of health care and social work intervention.     

Impact of a vocational counselor on employment-related outcomes among methadone patients

A vocational rehabilitation counselor (VRC) was placed in a methadone maintenance (MM) clinic (Clinic 1; N=333) to increase vocational–educational (v–e) services and improve v–e outcomes. Data on individual service delivery and monthly patient v–e status provided project implementation and outcome data, respectively, in Clinic 1; v–e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. V–e services increased significantly in Clinic 1; net v–e involvement increased from 53 to 56% in Clinic 1 and declined in Clinic 2, 45–43%. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v–e change and that VRC services contributed significantly to v–e change among patients not working at admission. It was concluded that placing a VRC in an MM clinic is a cost-effective v–e intervention.     

A model-guided process evaluation: Office-based prescribing and pharmacy dispensing of methadone

This article presents an exemplar of a model-guided process evaluation that specifies the treatment model, assesses its implementation, monitors the fidelity of the model throughout the project, assesses model exposure and absorption, and helps understand the program's intermediate effects (proximal outcomes) as well as final effects (distal outcomes). The New Mexico study on office-based prescribing and community pharmacy dispensing of methadone is a research demonstration project that phases a small group of female methadone maintenance patients out of methadone clinics and into a program where they will obtain their scheduled doses of methadone at pharmacies that work in collaboration with physicians and a social worker.The patient's methadone treatment will in this way become part of their overall health care. Early detection of problems of implementation (e.g., the omission of program content or the delivery of inaccurate information) enables the researcher to make adjustments before the problems become unmanageable and the integrity of the original research design is compromised. A model-guided process evaluation can critically inform health services research demonstrations designed for enabling continuous, ongoing feedback and improvement of client-related services.     

Toward a dynamic analysis of disease-state transition monitored by serial clinical laboratory tests

A closed stochastic 3-compartment system is proposed to model data from a randomized comparative clinical trial with the purpose of evaluating the efficacy of the new drug Buprenorphine against that of the commercially available drug Methadone for the treatment of opiate addiction. The results showed that, relative to Methadone, Buprenorphine was more efficacious with steadfast drug action---patients on Buprenorphine treatment tended to achieve an opiate-negative state faster and upon reaching that state they stayed there longer.     

Child protection and out-of-home placement experiences of preschool children born to mothers enrolled in methadone maintenance treatment during pregnancy

Children born to opiate-dependent women engaged in methadone maintenance treatment are at high risk of child welfare concern. However, few studies have examined the early child protection service (CPS) contacts of this group or the risk factors that place some but not other mother–infant dyads at increased risk of serious concern resulting in the removal of the child from the family home. As part of a prospective longitudinal study based in New Zealand, 73 women enrolled in methadone maintenance treatment during pregnancy and 54 non-methadone maintained comparison mothers were recruited during pregnancy and interviewed close to delivery, 18-months and 4.5-years. At each follow-up evaluation, detailed life history methods were used to describe children's family circumstances and all CPS contacts. By 4.5-years postdelivery, methadone maintained mothers were ten-times more likely to have been investigated by child protection services than comparison mothers (59% v. 6%, p < .001). Of these contacts, almost half (44%) resulted in the removal of the child from the family home compared to no comparison children (p < .001). These children were most frequently placed before age 1, with an average of 1–2 caregiver changes (range: 0–7). In addition to maternal methadone maintenance treatment during pregnancy (p < .001), significant independent predictors of child out-of-home placement included maternal depression (p = .01), maternal history of child custody loss (p = .02), and to some extent, high levels of family socioeconomic adversity (p = .06). Findings highlight the complex psychosocial needs of this high-risk group, as well as the need for careful monitoring and parenting support following hospital discharge.