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Publisher: Cochrane Collaboration
Languages: English
Types: Article
Subjects:
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 strategy 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lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs.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.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1.Cochrane Central Register of Controlled Trials, which includes
    • TRAL - The Cochrane Library issue 4, 2008)
    • 2.PubMed (January 2001 - December 2008)
    • 3.Embase (January 2001- December 2008)
    • 4.CINAHL (January 2001 - December 2008)
    • For details on searches see Appendix 1; Appendix 2; Appendix 3;
    • Appendix 4
    • alcohol research information specialist. 1. Some of the main electronic sources of ongoing trials
    • Clinical Trials.gov, Agenzia Italiana del Farmaco) 2. Conference proceedings likely to contain trials relevant to
    • the review (College on Problems of Drug Dependence - CPDD) 3. Library of Congress databases were also searched for studies
    • and randomised control trial. 4. National focal points for drug research (e.g., National
    • Research Centre (NDARC)) 5. Reference lists of all relevant papers to identify further
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    • Gibson 2008 Gibson A, Degenhardt L, Mattick RP, Ali R, White J, O'Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction 2008;103:462-8.
    • Gowing 2004 Gowing L, Farrell M, Bornemann R, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004145]
    • Hargreaves 1983 Hargreaves W. Methadone dosage and duration for maintenance treatment.. In: J Cooper, F Altman, B Brown, D Czechowicz editor(s). Research on the treatment of narcotic addiction: State of the art. Rockville, MD: National Institute on Drug Abuse, 1983.
    • Higgins 2008 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated February 2008]. The Cochrane Collaboration, 2008. www.cochranehandbook.org.
    • Jaffe 1990 Jaffe, J. Drug addiction and drug abuse. In: A Gilman, T Rall, A Nies, P Taylor editor(s). The pharmacological basis of therapeutics. 8th Edition. New York: Pergamon Press, 1990:522-73.
    • Lind 2005 Lind B, Chen S, Weatherburn D, Mattick R. The effectiveness of methadone maintenance treatment in controlling crime. An Australian aggregate-level analysis. Journal of Criminology 2005;45:201-11.
    • Mattick 1993 Mattick R P, Hall W. A treatment outline for approaches to opioid dependence: Quality assurance project. Canberra: Australian Government Publishing Service, 1993.
    • Mattick 1996 Mattick RP, Hall W. Are detoxification programmes effective?. Lancet 1996;347:97-100.
    • Ward 1992 Ward J, Mattick R P, Hall W. Key issues in methadone maintenance treatment. Sydney: New South Wales University Press, 1992.
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