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Retention in publicly funded methadone maintenance treatment in two western states

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Abstract

This study examined individual and system characteristics associated with retention in methadone maintenance treatment among Medicaid-eligible adults in treatment for opiate use in Oregon and Washington. Logistic regression was used to examine the contributions of predisposing, need, and enabling characteristics on 365 day retention in methadone maintenance treatment. Older patients, patients with a history of methadone maintenance treatment, and persons with stable Medicaid eligibility had higher rates of retention than did patients with disabilities, polysubstance users, and those with an arrest record. In Oregon, which delivers methadone maintenance treatment through managed care, retention rose sharply from 28% to 51% between 1994 and 1998 and then leveled off. During the same time period, retention in Washington State grew from 28% to 34%. The higher rates of retention in Oregon, in part, can be explained by differences in service delivery influenced by financing. Faced with long waiting lists, Washington providers were more than twice as likely to administratively discharge patients for rule violations as their Oregon counterparts. Given the importance of retention, policies and practices that influence retention should be carefully considered. Because Medicaid eligibility has a dramatic impact on retention, policies that help extend eligibility or stabilize eligibility among individuals actively engaged in treatment should be carefully considered.

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References

  1. Simpson DD, Sells SB. Effectiveness of treatment for drug abuse: an overview of the DARP research program.Advances in Alcohol and Substance Abuse. 1982;2:7–29.

    Google Scholar 

  2. Maddux JF, Desmond DP. Outcomes of methadone maintenance 1 year after admission.Journal of Drug Issues. 1997;27(2):225–238.

    Google Scholar 

  3. Simpson DD, Joe GW, Dansereau DF, et al. Strategies for improving methadone treatment process and outcomes.Journal of Drug Issues. 1997;27(2):239–260.

    Google Scholar 

  4. Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence.The Lancet. 1999;353:221–226.

    Google Scholar 

  5. National Institutes of Health, National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective medical treatment of opiate addiction.JAMA. 1998;280(22):1936–1943.

    Google Scholar 

  6. Sees KL, Delucchi KL, Masson C, et al. Methadone maintenance vs. 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial.JAMA. 2000;283:1303–1310.

    Google Scholar 

  7. Zhang Z, Friedmann PD, Gerstein DR. Does retention matter? Treatment duration and improvement in drug use.Addiction. 2003;98:673–684.

    Google Scholar 

  8. Cacciola JS, Alterman AI, Rutherford MJ, et al. The early course of change in methadone maintenance.Addiction. 1998;93(1):41–49.

    Google Scholar 

  9. Hubbard RL, Craddock SG, Flynn PM, et al. Overview of 1-year follow-up outcomes in the drug abuse treatment outcome study (DATOS).Psychology of Addictive Behaviors. 1997;11(4):261–278.

    Google Scholar 

  10. Simpson DD, Joe GW, Brown BS. Treatment retention and follow-up outcomes in the drug abuse treatment outcomes study (DATOS).Psychology of Addictive Behaviors. 1997;11(4):294–307.

    Google Scholar 

  11. Serpelloni G, Carrieri MP, Binkin N, et al. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study.AIDS Care. 1994;6(2):215–220.

    Google Scholar 

  12. Hartel DN, Schoenbaum E. Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City.Public Health Reports. 1998;113(suppl 1):107–115.

    Google Scholar 

  13. Bell J, Hall W, Byth K. Changes in criminal activity after entering methadone maintenance.British Journal of Addiction. 1992;87:251–258.

    Google Scholar 

  14. Flynn PM, Porto JV, Rounds-Bryant JL, et al. Costs and benefits of methadone treatment in DATOS, 1: discharge versus continuing patients.Journal of Maintenance in the Addictions. 2003;2(1/2):129–149.

    Google Scholar 

  15. Caplehorn JRM, Dalton MSYN, Cluff MC, et al. Retention in methadone maintenance and addicts' risk of death.Addiction. 1994;89:203–207.

    Google Scholar 

  16. Simpson DD, Joe GW, Broome KM, et al. Program diversity and treatment retention rates in the drug abuse treatment outcome study (DATOS).Psychology of Addictive Behaviors. 1997;11(4):279–293.

    Google Scholar 

  17. Greenfield L, Brady JV, Besteman KJ, et al. Patient retention in mobile and fixed-site methadone maintenance treatment.Drug and Alcohol Dependence. 1996;42:125–131.

    Google Scholar 

  18. Friedmann PD, Lemon SC, Stein MD. Transportation and retention in outpatient drug abuse treatment programs.Journal of Substance Abuse Treatment. 2001;21:97–103.

    Google Scholar 

  19. Hubbard RL, Marsden ME, Rachal JV, et al.Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill: University of North Carolina Press; 1989.

    Google Scholar 

  20. Magura S, Nwakeze PC, Demsky S. Pre- and in-treatment predictors of retention in methadone treatment using survival analysis.Addiction. 1998;93(1):51–60.

    Google Scholar 

  21. Rowan-Szal GA, Chatham LR, Simpson DD. Importance of identifying cocaine and alcohol dependent methadone clients.The American Journal on Addictions. 2000;9:38–50.

    Google Scholar 

  22. Joe GW, Simpson DD, Broome KM. Effects of readiness for drug abuse treatment on client retention and assessment of process.Addiction. 1998;93(8):1177–1190.

    Google Scholar 

  23. Grella CE, Wugalter SE, Anglin MD. Predictors of treatment retention in enhanced and standard methadone maintenance treatment for HIV risk reduction.Journal of Drug Issues. 1997;27(2):203–224.

    Google Scholar 

  24. Saxon AJ, Wells EA, Fleming C, et al. Pre-treatment characteristics, program philosophy, and level of ancillary services as predictors of methadone maintenance treatment outcome.Addiction. 1996;91(8):1197–1209.

    Google Scholar 

  25. D'Aunno T, Pollack HA. Changes in methadone treatment practices: results from a national panel study, 1988–2000.JAMA. 2002;288(7):850–856.

    Google Scholar 

  26. Fiorentine R, Nakashima J, Anglin MD. Client engagement in drug treatment.Journal of Substance Abuse Treatment. 1999;17(3):199–206.

    Google Scholar 

  27. Rhoades HM, Creson D, Elk R, et al. Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.American Journal of Public Health. 1998;88(1):34–39.

    Google Scholar 

  28. Condelli WS. Strategies for increasing retention in methadone programs.Journal of Psychoactive Drugs. 1993;25(2):143–147.

    Google Scholar 

  29. Simpson DD, Joe GW. Motivation as a predictor for early dropout from drug abuse treatment.Psychotherapy. 1993;30(2):357–368.

    Google Scholar 

  30. Del Rio M, Mino A, Perneger TV. Predictors of patient retention in a newly established methadone maintenance treatment programme.Addiction. 1997;92(10):1353–1360.

    Google Scholar 

  31. Joe GW, Simpson DD, Hubbard RL. Treatment predictors of tenure in methadone maintenance.Journal of Substance Abuse. 1991;3:73–84.

    Google Scholar 

  32. Maxwell S, Shinderman MS. Optimizing long-term response to methadone maintenance treatment: a 152-week follow-up using higher-dose methadone.Journal of Addictive Diseases. 2002;21(3):1–12.

    Google Scholar 

  33. Strain EC, Bigelow GE, Liebson IA, et al. Moderate vs. high-dose methadone in the treatment of opioid dependence.JAMA. 1999;281(11):1000–1005.

    Google Scholar 

  34. Carlson MJ, Gabriel RM. Patient satisfaction, use of services, and one-year outcomes in publicly funded substance abuse treatment.Psychiatric Services. 2001;52(9):1230–1236.

    Google Scholar 

  35. Kwiatkowski CF, Booth RE, Lloyd LV. The effects of offering free treatment to street-recruited opioid injectors.Addiction. 2000;95(5):697–704.

    Google Scholar 

  36. Steenrod S, Brisson A, McCarty D, et al. Effects of managed care on programs and practices for the treatment of alcohol and drug dependence. InRecent Developments in Alcoholism. New York: Kluwer Academic/Plenum Publishers; 2001:51–71. Galanter M, ed.Services Research in the Era of Managed Care; vol 15.

    Google Scholar 

  37. Deck DD, McFarland BH, Titus JM, et al. Access to substance abuse treatment services under the Oregon Health Plan.JAMA. 2000;284(16):2093–2099.

    Google Scholar 

  38. Deck DD, Carlson MJ. Access to publicly funded methadone maintenance treatment in 2 western states.Journal of Behavioral Health Services Research. In press.

  39. Alexander JA, Nahra TA, Wheeler JRC. Managed care and access to substance abuse treatment services.Journal of Behavioral Health Services & Research. 2003;30(2):161–175.

    Google Scholar 

  40. Office of Alcohol and Drug Abuse Programs.Chemical Dependency Placement, Continued Stay and Discharge Criteria: Adult. Salem, Ore: Office of Alcohol and Drug Abuse Programs; 1995.

    Google Scholar 

  41. Deck DD, Gabriel RM, Knudsen J, et al. Impact of client placement criteria on substance abuse treatment under the Oregon Health Plan.Journal of Addictive Diseases. In press.

  42. Office of Medical Assistance Programs, Oregon Department of Human Resources.The Oregon Medicaid Reform Demonstration: A Waiver Amendment to Add Mental Health and Chemical Dependency Services to the Demonstration. Salem, Ore: Office of Medical Assistance Programs, Oregon Department of Human Resources; 1994.

    Google Scholar 

  43. Substance Abuse and Mental Health Services Administration, Office of Applied Studies.Treatment Episode Data Set (TEDS): 1992-2000. National Admissions to Substance Abuse Treatment Services. Rockville, Md: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2002. DASIS Series: S-17, DHHS Publication No. (SMA)02-3727.

    Google Scholar 

  44. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter?Journal of Health and Social Behavior. 1995;36(1):1–10.

    Google Scholar 

  45. Aday LA, Andersen RM. A framework for the study of access to medical care.Health Services Research. 1974;9:208–220.

    Google Scholar 

  46. Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people.Health Services Research. 2000;34(6):1273–1302.

    Google Scholar 

  47. Smedley BD, Stith AY, Nelson AR, eds..Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.

    Google Scholar 

  48. Assessment and Treatment Planning for Cocaine-Abusing Methadone-Maintained Patients.Treatment Improvement Protocol (TIP) Series 10. Rockville, Md: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment; 1994. DHHS Publication No. (SMA)94-3003.

    Google Scholar 

  49. Broomer KM, Flynn PM, Simpson DD. Psychiatric comorbidity measures as predictors of retention in drug abuse treatment programs.Health Services Research. 1999;34(3):791–806.

    Google Scholar 

  50. Grella CE, Anglin MD, Rawson R, et al. What happens when a demonstration project ends. Consequences for a clinic and its clients.Journal of Substance Abuse Treatment. 1996;13(3):249–256.

    Google Scholar 

  51. Green CA, Polen MR, Dickinson DM, Lynch FL, Bennett MD. Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program.Journal of Substance Abuse Treatment. 2002;23:285–295.

    Google Scholar 

  52. Bayley B, Denfeld D, Edlund C, et al.Continuity and Turbulence in an Expanded Medicaid Managed Care Program: The Oregon Health Plan Experience. Portland, Ore: Center for Outcomes Research and Education, Providence Health System; 2001.

    Google Scholar 

  53. Rosenbaum M, Washburn A, Knight K, et al. Treatment as harm reduction, defunding as harm maximization: the case of methadone maintenance.Journal of Psychoactive Drugs. 1996;28(3):241–249.

    Google Scholar 

  54. Anglin MD, Speckart GR, Booth MW, et al. Consequences and costs of shutting off methadone.Addictive Behavior. 1989;14(3):307–326.

    Google Scholar 

  55. Jackson TR. Treatment practice and research issues in improving opioid treatment outcomes.NIDA Science and Practice Perspectives. 2002;1(1):23–28. Available at: http://www.drugabuse.gov/PDF/Perspectives/vol1no1/04Perspectives-Opioid.pdf/. Accessed August 26, 2003.

    Google Scholar 

  56. Merrill JO. Policy progress for physician treatment of opiate addiction.Journal of General Internal Medicine. 2002;17:361–368.

    Google Scholar 

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Correspondence to Dennis Deck PhD.

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Deck, D., Carlson, M.J. Retention in publicly funded methadone maintenance treatment in two western states. The Journal of Behavioral Health Services & Research 32, 43–60 (2005). https://doi.org/10.1007/BF02287327

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