• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Jun 2003; 53(491): 461–467.
PMCID: PMC1314620

Does methadone maintenance treatment based on the new national guidelines work in a primary care setting?

Abstract

BACKGROUND: General practitioners (GPs) are being encouraged to treat more drug users but there are few studies to demonstrate the effectiveness of primary care treatment. AIM: To determine whether patients retained on methadone maintenance treatment for one year in a modern British primary care setting, with prescribing protocols based on the new national guidelines, can achieve similar harm reduction outcomes to those demonstrated in other settings, using objective outcome measures where available. DESIGN OF STUDY: Longitudinal cohort study. SETTING: The Primary Care Clinic for Drug Dependence, Sheffield. METHOD: The intervention consisted of a methadone maintenance treatment provided by GPs with prescribing protocols based on the 1999 national guidelines. The first 96 eligible consenting patients entering treatment were recruited; 65 completed the study. Outcome measures were current drug use, HIV risk-taking behaviour, social functioning, criminal activity, and mental and physical health, supplemented by urinalysis and criminal record data. RESULTS: Frequency of heroin use was reduced from a mean of 3.02 episodes per day (standard deviation [SD] = 1.73) to a mean of 0.22 episodes per day (SD = 0.54), (chi 2 = 79.48, degrees of freedom [df] = 2, P < 0.001), confirmed by urinalysis. Mean numbers of convictions and cautions were reduced by 62% (z = 3.378, P < 0.001) for all crime. HIV risk-taking behaviour, social functioning, and physical and psychological wellbeing all showed significant improvements. CONCLUSION: Patients retained on methadone maintenance treatment for one year in a primary care setting can achieve improvements on a range of harm reduction outcomes similar to those shown by studies in other, often more highly structured programmes.

Full Text

The Full Text of this article is available as a PDF (85K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence. Lancet. 1999 Jan 16;353(9148):221–226. [PubMed]
  • Farrell M, Ward J, Mattick R, Hall W, Stimson GV, des Jarlais D, Gossop M, Strang J. Methadone maintenance treatment in opiate dependence: a review. BMJ. 1994 Oct 15;309(6960):997–1001. [PMC free article] [PubMed]
  • Marsch LA. The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction. 1998 Apr;93(4):515–532. [PubMed]
  • Keen J. Managing drug misuse in general practice. New department of health guidelines provide a benchmark for good practice. BMJ. 1999 Jun 5;318(7197):1503–1504. [PMC free article] [PubMed]
  • Hutchinson SJ, Taylor A, Gruer L, Barr C, Mills C, Elliott L, Goldberg DJ, Scott R, Gilchrist G. One-year follow-up of opiate injectors treated with oral methadone in a GP-centred programme. Addiction. 2000 Jul;95(7):1055–1068. [PubMed]
  • Gruer L, Wilson P, Scott R, Elliott L, Macleod J, Harden K, Forrester E, Hinshelwood S, McNulty H, Silk P. General practitioner centred scheme for treatment of opiate dependent drug injectors in Glasgow. BMJ. 1997 Jun 14;314(7096):1730–1735. [PMC free article] [PubMed]
  • Gossop M, Marsden J, Stewart D, Lehmann P, Strang J. Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study. Br J Gen Pract. 1999 Jan;49(438):31–34. [PMC free article] [PubMed]
  • Greenwood J. Persuading general practitioners to prescribe--good husbandry or a recipe for chaos? Br J Addict. 1992 Apr;87(4):567–575. [PubMed]
  • Glanz A. Findings of a national survey of the role of general practitioners in the treatment of opiate misuse: views on treatment. Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):543–545. [PMC free article] [PubMed]
  • Caplehorn JR, Dalton MS, Cluff MC, Petrenas AM. Retention in methadone maintenance and heroin addicts' risk of death. Addiction. 1994 Feb;89(2):203–209. [PubMed]
  • Magura S, Nwakeze PC, Demsky SY. Pre- and in-treatment predictors of retention in methadone treatment using survival analysis. Addiction. 1998 Jan;93(1):51–60. [PubMed]
  • Strain EC, Bigelow GE, Liebson IA, Stitzer ML. Moderate- vs high-dose methadone in the treatment of opioid dependence: a randomized trial. JAMA. 1999 Mar 17;281(11):1000–1005. [PubMed]
  • D'Ippoliti D, Davoli M, Perucci CA, Pasqualini F, Bargagli AM. Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage. Drug Alcohol Depend. 1998 Oct 1;52(2):167–171. [PubMed]
  • Bertschy G. Methadone maintenance treatment: an update. Eur Arch Psychiatry Clin Neurosci. 1995;245(2):114–124. [PubMed]
  • Caplehorn JR. A comparison of abstinence-oriented and indefinite methadone maintenance treatment. Int J Addict. 1994 Sep;29(11):1361–1375. [PubMed]
  • Gossop M, Marsden J, Stewart D, Treacy S. Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Depend. 2001 May 1;62(3):255–264. [PubMed]
  • Keen J, Rowse G, Mathers N, Campbell M, Seivewright N. Can methadone maintenance for heroin-dependent patients retained in general practice reduce criminal conviction rates and time spent in prison? Br J Gen Pract. 2000 Jan;50(450):48–49. [PMC free article] [PubMed]
  • Gossop M, Marsden J, Stewart D, Rolfe A. Patterns of improvement after methadone treatment: 1 year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Depend. 2000 Nov 1;60(3):275–286. [PubMed]
  • Ward J, Darke S, Hall W, Mattick R. Methadone maintenance and the human immunodeficiency virus: current issues in treatment and research. Br J Addict. 1992 Mar;87(3):447–453. [PubMed]
  • Adelekan M, Green A, Dasgupta N, Tallack F, Stimson GV, Wells B. Reliability and validity of the Opiate Treatment Index among a sample of opioid users in the United Kingdom. Drug Alcohol Rev. 1996 Sep;15(3):261–270. [PubMed]
  • Reno RR, Aiken LS. Life activities and life quality of heroin addicts in and out of methadone treatment. Int J Addict. 1993 Feb;28(3):211–232. [PubMed]
  • Healey A, Knapp M, Astin J, Gossop M, Marsden J, Stewart D, Lehmann P, Godfrey C. Economic burden of drug dependency. Social costs incurred by drug users at intake to the National Treatment Outcome Research Study. Br J Psychiatry. 1998 Aug;173:160–165. [PubMed]
  • Gossop M, Marsden J, Stewart D, Rolfe A. Patterns of drinking and drinking outcomes among drug misusers. 1-year follow-up results. J Subst Abuse Treat. 2000 Jul;19(1):45–50. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Compound
    Compound
    PubChem Compound links
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links