TY - JOUR
T1 - Evidence-based treatment for opioid use disorders
T2 - A national study of methadone dose levels, 2011–2017
AU - D'Aunno, Thomas
AU - Park, Sunggeun (Ethan)
AU - Pollack, Harold A.
N1 - Funding Information:
*Order of authorship is alphabetical. This work was supported by 5R01DA024549 from the National Institute on Drug Abuse (NIDA). The contents are solely our responsibility and do not necessarily represent the view of the US Department of Health and Human Services or NIDA.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/1
Y1 - 2019/1
N2 - The nation's methadone maintenance treatment (MMT) programs play a central role in addressing the current opioid epidemic. Considerable evidence documents the treatment effectiveness of MMT and, in turn, the importance of adequate dosing to MMT's effectiveness. Yet, as recently as 2011, 41% of patients received doses below the level of 80 mg/day. Using survey data from a nationally representative sample of MMT programs in 2011 and 2017, we examine (1) the extent to which the nation's MMT programs are meeting evidence-based standards for methadone dose level and (2) characteristics of MMT programs that are associated with variation in performance. Our results show that 43% of MMT patients receive <80 mg/day in 2017, and 23% of methadone maintenance patients receive daily doses below 60 mg. Results from multivariate regression analysis of the 2017 survey data show that private for-profit and public organizations significantly under-dosed patients compared to private nonprofit providers. Under-dosing also was more common in programs that serve high proportions of African-American patients. These results are concerning because MMT remains the medication of choice for vulnerable patients with the most severe opioid use disorders, and for-profit providers treat a growing proportion of MMT patients.
AB - The nation's methadone maintenance treatment (MMT) programs play a central role in addressing the current opioid epidemic. Considerable evidence documents the treatment effectiveness of MMT and, in turn, the importance of adequate dosing to MMT's effectiveness. Yet, as recently as 2011, 41% of patients received doses below the level of 80 mg/day. Using survey data from a nationally representative sample of MMT programs in 2011 and 2017, we examine (1) the extent to which the nation's MMT programs are meeting evidence-based standards for methadone dose level and (2) characteristics of MMT programs that are associated with variation in performance. Our results show that 43% of MMT patients receive <80 mg/day in 2017, and 23% of methadone maintenance patients receive daily doses below 60 mg. Results from multivariate regression analysis of the 2017 survey data show that private for-profit and public organizations significantly under-dosed patients compared to private nonprofit providers. Under-dosing also was more common in programs that serve high proportions of African-American patients. These results are concerning because MMT remains the medication of choice for vulnerable patients with the most severe opioid use disorders, and for-profit providers treat a growing proportion of MMT patients.
KW - Methadone
KW - Opioid-related disorders
KW - Substance use treatment
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U2 - 10.1016/j.jsat.2018.10.006
DO - 10.1016/j.jsat.2018.10.006
M3 - Article
C2 - 30466543
AN - SCOPUS:85055052168
SN - 0740-5472
VL - 96
SP - 18
EP - 22
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
ER -