Treatment Fees and Retention on Methadone Maintenance

• Date: 01 July 1994
• Author: Thomas J. Prihoda,David P. Desmond,James F. Maddux
• DOI: 10.1177/002204269402400305
• Published date: 01 July 1994
• Subject Matter: Article

The Journal of Drug Issues 24(3),429-443 1994

TREATMENT FEES AND RETENTION ON METHADONE

MAINTENANCE

James F. Maddux

Thomas J. Prihoda

David P. Desmond

Several

reports

have

suggested

that

required

treatment

fees

impair

retention

on

methadone

maintenance.

In a

controlled

study,

152 illicitopioid

users

admitted

to

methadone

maintenance

were

randomly

assigned

to fee or no-

fee

status.

The

fee

subjects

were

required

to pay afee of $2.50per day and

the

no-fee

subjects

were

required

to pay

nothing.

Elimination

of fees

significantly

increased

retention.

Only

34%

of thefee

subjects

but 54% of

the

no-fee

subjects

were

retained

for one

year.

Of

those

retained

for one

year,

the fee

subjects

and the

no-fee

subjects

showed

only

small and

nonsignificant

differences

on

urine

test

results

and

measures

of

social

performance.

Interviews

per

month

with

caseworker

were

inversely

related

to

retention.

Increased

interviews

and

decreased

retention

may

both

have

reflected

treatment

problems

of

subjects.

Introduction

Since

methadone maintenance was introduced in 1965, many studies have

found that opioid users reduce their illicit opioid use and improve their social

performance while maintained on methadone (Senay 1985; Platt 1986; Woody and

O'Brien 1986; Hubbard et al. 1989; Lowinson et al. 1992). When they leave

treatment, however, most resume illicit opioid use (Dole and Joseph 1978; Ball

and Ross 1991). The effectiveness of methadone maintenance seems to depend on

continued treatment. Retention in treatment has become more urgent with the

recognition in the 1980s that the acquired immunodeficiency syndrome (AIDS) is

spread through sharing of injection equipment (Cooper 1989). Despite the

importance of retention in treatment, reported one-year retention rates among

methadone programs have varied widely (Maddux 1993), from 89% (Gearing

1974) to 34% (Hubbard et al. 1989). The sources of these widely varying rates

James

F.

Maddux.

M.D., serves as professor in the Department of Psychiatry of the University of Texas Health

Science Center at San Antonio. He is principal investigator of a NIDA-supported project to improve methadone and

has authored or co-authored over fifty published articles in the field of substance abuse.

Thomas

J.

Prihoda,

Ph.D., is an assistant professor and has been on the facully of the University of Texas Health Science Center at San

Antonio since 1982. He has been an investigator on several research projects and has authored or co-authored over

fifty publications in which he was responsible for the statistical content, David P. Desmond. M.S. W.• has served

as senior research associate and Instructor in the Department of Psychiatry of the University of Texas Health

Science Center at San Antonio since 1971. His research interests include the etiology. natural history. and treatment

of substance abuse. This article was presented in part at the annual meeting of the College on Problems of Drug

Dependence in Toronto, 14 June 1993. Send reprint requests to James F. Maddux, M.D., Department of

PSYChiatry,

UTHSCSA, 7703 Floyd Curl Drive, San Antonio TX 78284-7792.

©Journal of Drug Issues, Inc. 002-0426/94/03/429-443 $1.00

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