Are 2 weeks of 'take-home' privileges beneficial for patients' long-term outcome in a methadone maintenance treatment program?

摘要

Objective: Patients in Israeli methadone maintenance treatment can achieve a maximum of 2 weeks of take-home dose (13-THD) privileges after at least 2 years since the achievement of 1-week privileges (6-THD). Patients who ever achieved 6-THD were characterized to predict achievement of 13-THD. Methods: All patients who ever achieved 6-THD and then achieved 13-THD were studied (December 2010-December 2012). Information on drugs in urine on admission, demographics, and addiction characteristics was retrieved from medical charts. Retention in treatment and durationwithTHDwere calculated and analyzed by Kaplan- Meier and Cox model regression. Results: Fifty-five of the 161 patients who achieved 6-THD also achieved 13-THD. No benzodiazepine abuse on admission (odds ratio [OR]=2.3, 95% confidence interval [CI]: 1.1-4.7), being Israeli-born (OR = 2.3, 95% CI: 1.1-5.2), and less than 12 years of education (OR = 2.8, 95% CI: 1.1-7.1) predicted the 13-THD achievers. The time to achieve 6-THD was shorter for the 13-THD patients than for the 106 who achieved only 6-THD (1.7 ± 1.5 vs 2.3 ± 2.0 years, P = 0.07).After losingTHDprivileges, the 13-THD group showed aworse outcome than the 6-THD group: 1 year after losing 6-THD (n = 92) or 13-THD (n = 27), 3.3% of the former left treatment versus 14.8% of the latter, whereas 83.7% versus 70.4%, respectively, succeeded in regaining any THD and 12.0% versus 14.8%, respectively, failed altogether. Conclusions: Patients who achieved 13-THD were characterized by more rapid progress in rehabilitation, but those who failed and lost 13-THD privileges were at a higher risk to deteriorate further than those who failed after achieving 6-THD.