Variations in methadone treatment practices. Results from a national study.

OBJECTIVE

To examine the extent to which outpatient methadone maintenance treatment units are engaging in treatment practices that previous research indicates are ineffective (eg, inadequate dose levels); to examine factors that may be related to variation in methadone treatment practices.

DESIGN

Survey of unit directors and clinical supervisors.

SETTING

The study includes units that vary in terms of ownership (public, private for-profit, or private not-for-profit) and setting (eg, hospital-based, mental health center-based, or free-standing facility).

PARTICIPANTS

A national random sample of 172 units participated, for an 82% response rate; the data were weighted to ensure that they were nationally representative.

MAIN OUTCOME MEASURES: Clients' awareness of and influence on doses; units' use of take-home dosages; upper limits on doses; average dose levels; unit emphasis on decreasing dosages; time when clients are encouraged to detoxify; average length of treatment.

RESULTS

The data indicate that many units have treatment practices such as low average dose levels that are not effective according to the majority of previous studies. Units with higher average dose levels have longer average lengths of time in treatment.

CONCLUSIONS

Steps should be taken to monitor and, if necessary, change the treatment practices of methadone units that are providing inadequate dose levels with little client input.