TY  - JOUR
T1  - Changes in methadone treatment practices: Results from a national panel study, 1988-2000
AU  - D'Aunno T, Pollack HA
Y1  - 2002/08/21
N1  - 10.1001/jama.288.7.850
JO  - JAMA
SP  - 850
EP  - 856
VL  - 288
IS  - 7
N2  - Context 
                  Results from several studies conducted in the early 1990s showed that
the majority of US methadone maintenance programs did not use treatment practices
that met established standards for the care of heroin users. Effective treatment
for heroin users is critical given the upsurge in heroin use and the continued
role of injection drug use in the human immunodeficiency virus and hepatitis
C epidemics.Objectives 
                  To examine the extent to which US methadone maintenance treatment programs
have made changes in the past 12 years to provide adequate methadone doses
and to identify factors associated with variation in program performance.Design, Setting, and Participants 
                  Program directors and clinical supervisors of nationally representative
methadone treatment programs that varied by ownership (for-profit, public,
or private not-for-profit) and setting (eg, free-standing, hospital-based)
were surveyed in 1988 (n = 172), 1990 (n = 140), 1995 (n = 116), and 2000
(n = 150).Main Outcome Measures 
                  Percentage of patients in each treatment program receiving methadone
dosages of less than 40, 60, and 80 mg/d.Results 
                  The percentage of patients receiving methadone dosage levels less than
the recommended 60 mg/d has decreased from 79.5% in 1988 to 35.5% in 2000.
Results also show that programs with a greater percentage of African American
patients are especially likely to dispense low dosages, while programs with
Joint Commission on Accreditation of Healthcare Organizations accreditation
are more likely to provide adequate methadone doses.Conclusions 
                  Efforts to improve methadone treatment practices appear to be making
progress, but many patients are still receiving substandard care.
SN  - 0098-7484
M3  - doi: 10.1001/jama.288.7.850
UR  - http://dx.doi.org/10.1001/jama.288.7.850
ER  -