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      Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence

      systematic-review

      , , ,

      Cochrane Drugs and Alcohol Group

      The Cochrane Database of Systematic Reviews

      John Wiley & Sons, Ltd

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          Abstract

          Background

          Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best‐researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed.

          Objectives

          To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug‐free rehabilitation, placebo medication, wait‐list controls) for opioid dependence.

          Search methods

          We searched the following databases up to Dec 2008: the Cochrane Controlled Trials Register, EMBASE, PubMED, CINAHL, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF‐VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs.

          Selection criteria

          All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non‐pharmacological therapy for the treatment of opioid dependence.

          Data collection and analysis

          Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta‐analysis and double‐entered.

          Main results

          Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double‐blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non‐pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56‐0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12‐1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10‐2.39).

          Authors' conclusions

          Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.

          Plain language summary

          Methadone maintenance therapy versus no opioid replacement therapy

          Methadone maintenance treatment can keep people who are dependent on heroin in treatment programs and reduce their use of heroin. Methadone is the most widely used replacement for heroin in medically‐supported maintenance or detoxification programs. Several non‐drug detoxification and rehabilitation methods are also used to try and help people withdraw from heroin. However the review found that people have withdrawn from trials when they are assigned to a drug‐free program. Consequently, there are no trials comparing methadone maintenance treatment with drug‐free methods other than methadone placebo trials, or comparing methadone maintenance with methadone for detoxification only. These trials show that methadone can reduce the use of heroin in dependent people, and keep them in treatment programs.

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          Author and article information

          Contributors
          R.Mattick@unsw.edu.au
          Journal
          Cochrane Database Syst Rev
          Cochrane Database Syst Rev
          14651858
          10.1002/14651858
          The Cochrane Database of Systematic Reviews
          John Wiley & Sons, Ltd (Chichester, UK )
          1469-493X
          8 July 2009
          July 2009
          4 May 2009
          : 2009
          : 3
          Affiliations
          University of New South Wales deptNational Drug and Alcohol Research Centre National Drug and Alcohol Research Centre University of New South Wales Sydney New South Wales Australia 2052
          London School of Hygiene and Tropical Medicine deptCentre for Research on Drugs and Health Behaviour Keppel Street London UK WC1E 7HT
          ASL RM/E deptDepartment of Epidemiology Via di Santa Costanza, 53 Rome Italy 00199
          Article
          PMC7097731 PMC7097731 7097731 CD002209.pub2 CD002209
          10.1002/14651858.CD002209.pub2
          7097731
          19588333
          Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
          Categories
          Opioids abuse and dependence
          Tobacco, drugs & alcohol

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