Methadone retention

evidenceMAT advocates frequently accuse me of “cherry picking” articles that paint a distorted and negative view of MAT. The irony is that most of the articles I link to are pointed to as evidence of MAT’s effectiveness. I’m just looking deeper into what the article actually says.

BASIS just shared an analysis of a new article about methadone retention. I’m not going to comment, just highlight some of the content.

The article starts of with this introduction:

Did you know that methadone maintenance treatment (MMT), is one of the most effective treatments for opioid use disorders, especially when patients stay in treatment for at least 12 months?

What’s behind that link to “most effective treatments”? (Those are not intended to be scare quotes. Just trying to keep the source clear.)

The effectiveness of MMT is most apparent in its ability to reduce drug-related criminal behaviors. MMT had a moderate effect in reducing illicit opiate use and drug and property-related criminal behaviors, and a small to moderate effect in reducing HIV risk behaviors.

It’s important to note Looking beyond the abstract of that “most-effective treatments” meta-analysis, here’s a little more on the issue of methadone’s effects on criminal activity:

The inability of methadone maintenance intervention to produce a consistent and substantial effect on both drug-and non-drug related crimes, when considered together, suggests that treatment effects are restricted to those crimes that are associated with drug use, and that some opiate-dependent individuals may have a propensity to engage in certain criminal behaviors not directly related to drug use. Indeed, many studies report a negligible effect on non-drug-related crimes, while reporting a significant effect on drug-related crimes (e.g. Cushman, 1971; Jacobs et al., 1978; Bale et al., 1980), with one study noting an increase in non-drug-related crimes after admission to methadone maintenance treatment (Boudoris, 1976).

The “most-effective treatments” meta-analysis does have a line that speaks to the relevance of the retention article that BASIS is analyzing.

Findings from these analyses must be generalized with caution. The majority of studies included in the analyses examined the status of only those participants who remained in treat- ment throughout the entire period of assessment, and excluded those who left treatment during the intervention period. It is quite probable that those participants remaining in treatment throughout the assessment period represent a more  “successful” subset of participants.

Ok. Back to the BASIS analysis of the retention study. What were the retention findings?

Almost 50% of the patients were still in treatment 6 months after starting, and about 20% were still in treatment at 12 months.