Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence. The effect of telephonic patient support on treatment for opioid dependence: outcomes at one year follow-up. Outpatient methadone maintenance treatment program. Quality of life and health of opioid-dependent persons in Lithuania. Physical and mental health in severe opioid-dependent patients within a randomized controlled maintenance treatment trial. Opioid substitution treatment reduces substance use equivalently in patients with and without posttraumatic stress disorder. Frequency, indications, outcomes, and predictive factors of opioid switching in an acute palliative care unit. Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT). Integration of health services improves multiple healthcare outcomes among HIV-infected people who inject drugs in Ukraine. Exposure to opioid maintenance treatment reduces long-term mortality. Community-based treatment for opioid dependent offenders: a pilot study. Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP A Clinical Trial Comparing Tapering Doses of Buprenorphine With Steady Doses for Chronic Pain and Coexistent Opioid Addiction Who benefits from additional drug counseling among prescription opioid-dependent patients receiving buprenorphine-naloxone and standard medical management? Sublingual Buprenorphine and Methadone Maintenance Treatment: A Three-Year Follow-Up of Quality of Life Assessment Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. Pre-treatment characteristics, program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome. Can reinforcement-based interventions to reduce drug use successfully be adapted to routine opioid maintenance treatment?
BACKGROUND There is increasing evidence that health-related quality of life ( HRQOL ) is associated with a successful treatment and better outcome in opioid addiction . The aim of the present study was the longitudinal investigation of HRQOL in patients with severe opioid dependence , who were r and omly assigned to four groups of medical and psychosocial treatment : heroin ( diacetylmorphine ) versus methadone and case management ( CM ) versus psychoeducation ( PSE ) respectively . METHODS HRQOL ( MSQoL ) and physical health ( OTI ) were investigated in 938 subjects , who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence . Data for the present analysis were taken from baseline and 12-month follow up . RESULTS Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period . HRQOL improvement under maintenance with heroin exceeded improvement under methadone , especially with regard to subjective physical health . HRQOL improvement was significantly associated with better expert-rated physical health . Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM . CONCLUSIONS The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better improvement of physical health under maintenance with heroin compared with methadone , which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence . Future studies need to investigate the benefits of PSE for patients in maintenance therapy OBJECTIVE The present study examined the impact of a telephonic patient support program known as HereToHelp ™ ( HTH ) on compliance and treatment outcomes among opioid dependent ( OD ) patients new to buprenorphine treatment ( BUP ) . METHOD A total of 1426 OD patients new to BUP were r and omized to receive BUP alone ( st and ard care ) or BUP plus the HTH patient support program .  All patients completed the Addiction Severity Index ( ASI ) at the time of enrollment , and at 12months post-enrollment . RESULTS Subjects r and omized to  the HTH support program who accepted at least 3 care coach intervention calls were more compliant  with BUP than the st and ard care group at month 12 ( 64.4 % vs. 56.1 % , χ(2)=5.09 , p<.025 ) . Compared to patients who were non-compliant with BUP , compliant patients reported significantly lower scores on all 7 of the ASI composite scores , indicating lower severity on addiction-related problems . CONCLUSIONS The HTH intervention seemed to improve patient treatment outcomes indirectly by improving compliance with BUP . Supplementing BUP with a structured , telephonic compliance-enhancement program is an effective way to improve compliance with medication which then improves patient outcomes BACKGROUND The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being . OBJECTIVE Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania . METHODS A total of 102 opioid-dependent patients were recruited in the study . A prospect i ve follow-up study design was used . To assess quality of life , the WHOQOL-BREF 26-item version was used . The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index ( OTI ) . RESULTS Following 6 months of methadone maintenance treatment , significant improvements in physical ( P=0.004 ) , psychological ( P=0.004 ) , and environmental ( P=0.048 ) components of quality of life were observed ; no statistically significant improvements were found in social component of quality of life . Study participants reported lower rates of medical morbidity associated with injection ( P<0.001 ) , cardiorespiratory ( P=0.034 ) , musculoskeletal ( P<0.001 ) , neurological ( P=0.013 ) , gastrointestinal ( P<0.001 ) , and general health ( P<0.001 ) . CONCLUSIONS Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients AIMS To evaluate physical and mental health and compare treatment outcomes in opiate-dependent patients substituted either with heroin or methadone .  DESIGN Twelve-month open-label r and omized controlled trial . SETTING Out-patient substitution clinics in seven German cities . PARTICIPANTS A total of 1015 opiate-dependent individuals . MEASUREMENTS Opiate Treatment Index-Health Scale Score ( OTI ) , Body Mass Index ( BMI ) , serology for infectious diseases such as hepatitis B , C and human immunodeficiency virus as well as tuberculosis , Karnofsky Performance Scale ( KPS ) , electrocardiogram ( ECG ) , echocardiogram , Symptom Checklist 90-R ( SCL-90-R ) , Global Assessment of Functioning ( GAF ) , Modular System for Quality of Life and study medication-related serious adverse events ( SAE ) . FINDINGS Improvements were found in both heroin and methadone substituted patients regarding OTI , BMI , KPS , SCL-90-R , and GAF , but they were more pronounced for the heroin group ( analysis of variance , all P = 0.000 ) . The frequency of pathological echocardiograms decreased in the heroin group and increased in the methadone group ( χ(2 ) test , < 0.05 ) . Markers for infectious diseases and frequencies of pathological ECGs did not differ between baseline and 12 months , or between treatment groups . Study medication-related serious adverse events , all of which were treated successfully , occurred 2.5 times more often in the heroin group . The majority of  heroin-related SAEs ( 41 of 58 ) occurred within a few minutes of the injections . CONCLUSIONS The integration of severe injection drug users either in methadone or heroin-assisted maintenance treatment has positive effects on most physical and mental change-sensitive variables , with heroin showing superior results . Due to medication-related adverse events , patients should be observed for 15 minutes after a heroin injection OBJECTIVE The purpose of this study was to determine whether opioid-dependent patients with diagnosed posttraumatic stress disorder ( PTSD ) have poorer long-term outcomes in opioid substitution treatment than do patients without PTSD . METHOD This prospect i ve observational study examined outcomes of 255 opioid-dependent patients ( men = 248 ) entering opioid substitution treatment at eight clinics in the Veterans Health Administration ( VHA ) . Subjects were interviewed at treatment entry , 6 months , and 1 year about substance use and related problems , health status , treatment satisfaction , and non-VHA health care utilization . Medical records were review ed to obtain toxicology results , health care utilization data , and diagnoses . Medical record review identified a diagnosis of PTSD in 71 ( 28 % ) patients . Substance-use and mental-health outcomes and health care utilization in the first year following treatment entry were compared between patients with and without a diagnosis of PTSD . RESULTS Patients with and without PTSD had similar treatment responses . Although patients with PTSD had longer histories of drug use at intake , at 1-year follow-up they showed reductions in heroin , cocaine , and alcohol use , comparable to patients without the disorder . PTSD patients received higher doses of opiate medication , attended more psychosocial treatment sessions for substance-use disorder , and had better treatment retention . Psychiatric symptoms for patients with PTSD were more severe at intake and showed little improvement throughout treatment . CONCLUSIONS Opioid substitution therapy is as effective at reducing substance use in PTSD patients as it is in patients without the disorder , but additional services are needed for treatment of psychological problems that are largely unchanged by treatment for addiction The aim of this study was to prospect ively evaluate the frequency , indications , outcomes , and predictive factors associated with opioid switching , using a protocol that had been clinical ly applied and viewed as effective for many years . A prospect i ve study was carried out on a cohort of consecutive cancer patients who were receiving opioids but had an unacceptable balance between analgesia and adverse effects , despite symptomatic treatment of side effects . The initial conversion ratio between opioids and routes was as follows ( mg/day ) : oral morphine 100=intravenous morphine 33=transdermal fentanyl 1=intravenous fentanyl 1=oral methadone 20=intravenous methadone 16=oral oxycodone 70=transdermal buprenorphine 1.3 . The switch was assisted by opioids used as needed , and doses were changed after the initial conversion according to clinical response in an acute care setting . Intensity of pain and symptoms associated with opioid therapy were recorded . A distress score ( DS ) was calculated as a sum of symptom intensity . A switch was considered successful when the intensity of pain and /or DS , or the principal symptom necessitating the switch , decreased to at least 33 % of the value recorded before switching . One hundred eighteen patients underwent opioid substitutions . The indications for opioid switching were uncontrolled pain and adverse effects ( 50.8 % ) , adverse effects ( 28.8 % ) , uncontrolled pain ( 15.2 % ) , and convenience ( 4.2 % ) . Overall , 103 substitutions were successful . Ninety-six substitutions were successful after the first switching , and a further substitution was successful in seven patients who did not respond to the first switch . The mean time to achieve dose stabilization after switching was 3.2 days . The presence of both poor pain control and adverse effects was related to unsuccessful switching ( P<0.004 ) . No relationship was identified between unsuccessful switching and the opioid dose , opioid sequence , pain mechanism , or use of adjuvant medications .  Opioid switching was an effective method to improve the balance between analgesia and adverse effects in more than 80 % of cancer patients with a poor response to an opioid . The presence of both poor pain relief and adverse effects is a negative factor for switching prognosis , whereas renal failure is not AIMS The R and omized Injectable Opioid Treatment Trial ( RIOTT ) compared supervised injectable heroin ( SIH ) and supervised injectable methadone ( SIM ) with optimized oral methadone ( OOM ) ( IS RCT N0133807 ) . Heroin addicts ( previously unresponsive to treatment ) made significant reductions in street heroin use at 6 months when treated with SIH . We now examine secondary outcomes . DESIGN Multi-site r and omized controlled trial ( RCT ) comparing SIH versus OOM and SIM versus OOM . SETTING Three supervised injectable opiate clinics in Engl and . PARTICIPANTS Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127 ) , r and omized to either SIH(n = 43 ) , SIM(n = 42 ) or OOM(n = 42 ) . All received high levels of medical and psychosocial support . MEASUREMENTS SECONDARY OUTCOMES wider drug use , crime , health and social functioning at 6 months . FINDINGS At 6 months , no significant differences were found between treatment groups in wider drug use ( crack/cocaine , benzodiazepines , alcohol ) , physical and mental health ( SF-36 ) or social functioning . Within each treatment group , significant reductions were observed in crime [ SIH = odds ratio ( OR ) 0.05 ; P < 0.001 ; SIM = OR 0.11 ; P = 0.002 ; OOM = OR 0.11 ; P = 0.003 ] and money spent per week on illicit drugs ( SIH = mean change £ -289.43 ; P < 0.001 ; SIM = mean change £ -183.41 ; P < 0.001 ; OOM = mean change £ -162.80 ; P < 0.001 ) , with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM ( mean difference £ -92.04 ; P < 0.001 ) . Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97 ; P = 0.008 ; SIM = mean change 4.73 ; P = 0.002 ) and mental health for OOM ( mean change 6.04 ; P = 0.013 ) . CONCLUSIONS Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use , crime , physical and mental health within a 6-month period , despite reducing street heroin use to a greater extent . However , all interventions were associated with improvements in these outcomes BACKGROUND People who inject drugs ( PWID ) experience poor outcomes and fuel HIV epidemics in middle-income countries in Eastern Europe and Central Asia . We assess integrated/co-located ( ICL ) healthcare for HIV-infected PWID , which despite international recommendations , is neither widely available nor empirically examined . METHODS A 2010 cross-sectional study r and omly sample d 296 HIV-infected opioid-dependent PWID from two representative HIV-endemic regions in Ukraine where ICL , non-co-located ( NCL ) and harm reduction/outreach ( HRO ) setting s are available .  ICL setting s provide onsite HIV , addiction , and tuberculosis services , NCLs only treat addiction , and HROs provide counseling , needles/syringes , and referrals , but no opioid substitution therapy ( OST ) . The primary outcome was receipt of quality healthcare , measured using a quality healthcare indicator ( QHI ) composite score representing percentage of eight guidelines -based recommended indicators met for HIV , addiction and tuberculosis treatment . The secondary outcomes were individual QHIs and health-related quality -of-life ( HRQoL ) . RESULTS On average , ICL- participants had significantly higher QHI composite scores compared to NCL- and HRO- participants ( 71.9 % versus 54.8 % versus 37.0 % , p<0.001 ) even after controlling for potential confounders . Compared to NCL- participants , ICL- participants were significantly more likely to receive antiretroviral therapy ( 49.5 % versus 19.2 % , p<0.001 ) , especially if CD4 ≤ 200 ( 93.8 % versus 62.5 % p<0.05 ) ; guideline -recommended OST dosage ( 57.3 % versus 41.4 % , p<0.05 ) ; and isoniazid preventive therapy ( 42.3 % versus 11.2 % , p<0.001 ) . Subjects receiving OST had significantly higher HRQoL than those not receiving it ( p<0.001 ) ; however , HRQoL did not differ significantly between ICL- and NCL- participants . CONCLUSIONS These findings suggest that OST alone improves quality -of-life , while receiving care in integrated setting s collectively and individually improves healthcare quality indicators for PWID AIMS To ( i ) examine the predictors of mortality in a r and omized study of methadone versus buprenorphine maintenance treatment ; ( ii ) compare the survival experience of the r and omized subject groups ; and ( iii ) describe the causes of death . DESIGN Ten-year longitudinal follow-up of mortality among participants in a r and omized trial of methadone versus buprenorphine maintenance treatment .  SETTING Recruitment through three clinics for a r and omized trial of buprenorphine versus methadone maintenance . PARTICIPANTS A total of 405 heroin-dependent ( DSM-IV ) participants aged 18 years and above who consented to participate in original study . MEASUREMENTS Baseline data from original r and omized study ; date s and causes of death through data linkage with Births , Deaths and Marriages registries ; and longitudinal treatment exposure via State health departments . Predictors of mortality examined through survival analysis . FINDINGS There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature . Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality ; there was no differential mortality among methadone versus buprenorphine participants . More dependent , heavier users of heroin at baseline had a lower risk of death , and also higher exposure to opioid treatment . Older participants r and omized to buprenorphine treatment had significantly improved survival . Aboriginal or Torres Strait Isl and er participants had a higher risk of death . CONCLUSIONS Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people . There was no differential reduction between buprenorphine and methadone . Previous studies suggesting differential effects may have been affected by biases in patient selection BACKGROUND Primary care opioid substitution treatment ( OST ) has not been compared to program-based OST for community-supervised offenders . OBJECTIVE The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes . METHODS This project r and omly assigned 15 jail diversion participants to either : ( i ) primary care buprenorphine OST , ( ii ) specialist facility buprenorphine OST , or ( iii ) specialist facility methadone OST . Participation lasted 13.5 months ( 12-month active treatment plus a post-participation visit ) . RESULTS All subjects endorsed 0 days of opioid use in the previous 14 at follow-up . Specialty care reduced HIV risk ( Risk Assessment Battery composite score ) over 6 months ( -.24 ± .17 ) compared to primary care ( .02 ± .14 ; p = .032 ) . CONCLUSION Findings support primary care OST feasibility for a community-supervised offender sample . Specialist care may facilitate improvements in secondary outcomes , such as HIV risk behaviors . SCIENTIFIC SIGNIFICANCE Further research is needed to clarify ( i ) the role of primary care in addicted offender management , and ( ii ) the matching of offenders , based upon history and co-morbidity , to care coordination conditions Background Economic evaluation normally requires information to be collected on outcome improvement using utility values . This is often not collected during the treatment of substance use disorders making cost-effectiveness evaluations of therapy difficult . One potential solution is the use of mapping to generate utility values from clinical measures . This study develops and evaluates mapping algorithms that could be used to predict the EuroQol-5D ( EQ-5D-5 L ) and the ICEpop CAPability measure for Adults ( ICECAP-A ) from the three commonly used clinical measures ; the CORE-OM , the LDQ and the TOP measures . Methods Models were estimated using pilot trial data of heroin users in opiate substitution treatment . In the trial the EQ-5D-5 L , ICECAP-A , CORE-OM , LDQ and TOP were administered at baseline , three and twelve month time intervals . Mapping was conducted using estimation and validation data sets . The normal estimation data set , which comprised of baseline sample data , used ordinary least squares ( OLS ) and tobit regression methods . Data from the baseline and three month time periods were combined to create a pooled estimation data set . Cluster and mixed regression methods were used to map from this data set . Predictive accuracy of the models was assessed using the root mean square error ( RMSE ) and the mean absolute error ( MAE ) . Algorithms were vali date d using sample data from the follow-up time periods . Results Mapping algorithms can be used to predict the ICECAP-A and the EQ-5D-5 L in the context of opiate dependence . Although both measures can be predicted , the ICECAP-A was better predicted by the clinical measures . There were no advantages of pooling the data . There were 6 chosen mapping algorithms , which had MAE scores ranging from 0.100 to 0.138 and RMSE scores ranging from 0.134 to 0.178 . Conclusion It is possible to predict the scores of the ICECAP-A and the EQ-5D-5 L with the use of mapping . In the context of opiate dependence , these algorithms provide the possibility of generating utility values from clinical measures and thus enabling economic evaluation of alternative therapy options . Trial registration IS RCT N22608399 . Date of registration : 27/04/2012 . Date of first r and omisation : 14/08/2012 Objectives : Effective strategies are needed to manage individuals with chronic noncancer pain and coexistent opioid addiction . This study compared opioid discontinuation and opioid replacement protocol s. Methods : We planned to enroll 60 individuals into an open-label trial who had been treated with opioids for chronic noncancer pain , and who also had opioid addiction . Participants were r and omly assigned to one of the two 6-month treatment protocol s of buprenorphine/naloxone sublingual tablets : ( 1 ) tapering doses for opioid weaning or “ detoxification ” ( active comparator group ) or ( 2 ) steady doses for opioid replacement ( experimental group ) . They were followed up monthly for the study outcomes : completion of the 6-month treatment protocol and self-reported pain control , physical functioning , alcohol consumption , and illicit drug use . Results : Enrollment was terminated after enrolling 12 participants because none of the 6 assigned to receive tapering doses could successfully complete the protocol ( 5 were given steady doses and 1 was admitted to an inpatient chemical dependency treatment program ) , whereas of the 6 assigned to receive steady doses , 5 completed the protocol ( 1 withdrew ) . This difference between the 2 treatment conditions was significant ( P = 0.015 ) . Of the 10 participants who completed the 6-month follow-up , 8 reported improved pain control and physical functioning and 5 used alcohol and /or illicit drugs . Conclusions : We conclude that during 6 months , these participants with chronic pain and coexistent opioid addiction were more likely to adhere to an opioid replacement protocol than an opioid weaning protocol and that opioid replacement therapy with steady doses of buprenorphine/naloxone is associated with improved pain control and physical functioning BACKGROUND In the multi-site Prescription Opioid Addiction Treatment Study ( POATS ) , conducted within the National Drug Abuse Clinical Trials Network , participants r and omly assigned to receive individual drug counseling in addition to buprenorphine-naloxone and medical management did not have superior opioid use outcomes . However , research with other substance-dependent population s shows that subgroups of participants may benefit from a treatment although the entire population does not . METHOD We conducted a secondary analysis of POATS data to determine whether a subgroup of participants benefited from drug counseling in addition to buprenorphine-naloxone and medical management , either due to greater problem severity or more exposure to counseling as a result of greater treatment adherence . Problem severity was measured by a history of heroin use , higher Addiction Severity Index drug composite score , and chronic pain . Adequate treatment adherence was defined a priori as attending at least 60 % of all offered sessions . RESULTS Patients who had ever used heroin and received drug counseling  were more likely to be successful ( i.e. , abstinent or nearly abstinent from opioids ) than heroin users who received medical management  alone , but only if they were adherent to treatment and thus received adequate exposure to counseling ( OR=3.7 , 95 % CI=1.1 - 11.8 , p=0.03 ) . The association between severity and outcome did not vary by treatment condition for chronic pain or ASI drug severity score . CONCLUSIONS These findings emphasize the importance of treatment adherence , and suggest that patients with prescription opioid dependence are a heterogeneous group , with different optimal treatment strategies for different subgroups This study was conducted to compare long-term outcome effects on the quality of life ( QOL ) of oral methadone with sublingual buprenorphine maintenance treatment . The QOL status of opioid-dependent patients was assessed using the German version ( “ Berlin Quality of Life Profile ” ) of the Lancashire Quality of Life Profile . Physical symptoms were measured using the Opiate Withdrawal Scale ( OWS ) . Urine tests were carried out r and omly to detect additional consumption . In the first study period , 53 opioid-dependent subjects were enrolled and 25 could be reached after 3 years . The retention rate was 50 % for methadone and 45 % for buprenorphine ( p = 0.786 ) . Baseline values of the total sample ( completers and noncompleters ) QOL and somatic complaints did not show significant differences between the two treatment groups . QOL characteristics at 6 months of treatment of the buprenorphine completer and noncompleter groups differed significantly regarding job ( p = 0.013 ) , family , and total score of physical symptoms ( p = 0.002 ) , in which the completer group showed the more favorable values . Concerning physical symptoms at 36 months , logistic regression revealed significantly less stomach cramps ( p = 0.037 ) and fatigue and tiredness ( p = 0.034 ) in buprenorphine compared to the methadone . Moreover , the buprenorphine-maintained group showed significantly less additional consumption of benzodiazepines ( p = 0.015 ) compared with methadone participants . It is concluded that opioid addicts improved their QOL and health status when treated with methadone or buprenorphine . In summary , regarding QOL and health status , the present data indicate that buprenorphine is also a useful long-term alternative for maintenance treatment of opioid-dependent patients This study is the first experimental trial to evaluate the effectiveness of a  Web-based behavioral intervention  when deployed in a model where it partially substituted for st and ard counseling in a community-based specialty addiction treatment program . New opioid-dependent intakes in methadone maintenance treatment ( n=160 ) were r and omly assigned for 12months to either : ( 1 ) st and ard treatment or ( 2 ) reduced st and ard treatment plus a Web-based psychosocial intervention , the Therapeutic Education System ( TES ) . Results demonstrated that replacing a portion of st and ard treatment with TES result ed in significantly greater rates of objective ly measured opioid abstinence ( 48 % vs. 37 % abstinence across all study weeks ; F(1 , 158)=5.90 , p<.05 and 59 % vs. 43 % abstinence on weeks participants provided urine sample s for testing ; F(1 , 158)=8.81 , p<.01 ) . This result was robust and was evident despite how opioid abstinence was operationally defined and evaluated . The potential implication s for service delivery models within substance abuse treatment programs and other healthcare entities are discussed Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy , nor have such predictors received much examination among recently treated , older cohorts of opioid addicts for whom drug use patterns have changed . Predictors of outcome were examined at 18 months post-treatment entry for 353 admissions to methadone maintenance who received r and om assignment to one of three counseling conditions : ( 1 ) medication only , ( 2 ) st and ard counseling and ( 3 ) enhanced services ; and one of two contingency conditions : ( 1 ) no contingencies , and ( 2 ) contingency contracting in a six-cell 3 x 2 design . Subjects in contingency contracting conditions were placed on contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use . All subjects completed the Addiction Severity Index ( ASI ) and provided weekly urine specimens . Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques . Interactions between subject characteristics by experimental condition assignment were also examined as predictors . Higher rates of total positive urine specimens were predicted by younger age , greater pre-treatment frequency of smoking cocaine , lower ASI psychiatric composite scores , and higher ASI legal composite scores . Higher rates of opiate positive specimens were predicted by younger age , lower pre-treatment frequency of alcohol intoxication , higher ASI legal and lower ASI employment and psychiatric composite scores , and assignment to medication only/no contingencies condition . Higher rates of cocaine positives were predicted by younger age , black race , lower ASI psychiatric composite score , greater pre-treatment frequency of intravenous and smoked cocaine use , less pre-treatment frequency of marijuana use , and lower methadone dose level . Assignment to enhanced/contingency contracting predicted lower rates of cocaine positives . Treatment retention was predicted by older age , non-black race , lower ASI legal composite score , higher methadone dose level and assignment to non-contingent conditions . While subject variables over which treatment providers have little control were , thus , related to outcome , type of treatment provided and methadone dose also influenced outcome INTRODUCTION Comorbid substance related disorders are a major health problem for patients in opioid maintenance treatment ( OMT ) . It was investigated whether a reinforcement scheme adapted to the regulatory and financial restrictions of routine treatment reduces concomitant drug use . METHODS OMT patients from 7 clinics who were using cocaine , benzodiazepines , heroin or amphetamines  were r and omly allocated to either treatment as usual ( n = 64 ) or treatment with an additional escalating reinforcement scheme ( n = 72 ) in which a patient 's number of weekly take-home dosages was increased after 1 , 4 , 8 and 12 consecutive weeks with drug-free urine specimens . Trial duration was 26 weeks . RESULTS Completion rates were 64 % for controls and 62.5 % in the experimental group . Mean number of drug-free weeks was 11.3 ( SD 8.5 ) for the control group and 9.8 ( 8.9 ) for the experimental group ( p = 0.30 ) . CONCLUSION The intervention was not effective compared to routine treatment . Additional features might be necessary to achieve an effect , e.g. a higher frequency of urine sampling or use of other reinforcers . It has to be further investigated how interventions which have been proven effective in experimental studies can successfully be adapted to routine care conditions
Dosage of pharmacologic medication and length of follow-up did not affect changes in domain scores .
WHOQOL-BREF and ASI domain scoring is a useful tool in measuring overall quality of life and levels of addiction among OST participants .
BACKGROUND Opioid substitution treatment ( OST ) can increase quality of life ( WHOQOL-BREF ) and reduce addiction severity index ( ASI ) scores among participants over time .
OST program participants have noted that improvement in quality of life is one of the most important variables to their reduction in drug use .
However , there is little systematic underst and ing of WHOQOL-BREF and ASI domain changes among OST participants in low and middle-income countries ( LMIC ) .