NDARC Technical Report no. 41 (1996)
EXECUTIVE SUMMARY
A large number of studies have shown methadone maintenance treatment to be effective when delivered from specialist clinics to selected populations of opioid dependent clients. However, recent evidence from The Netherlands suggests that methadone programs that have relaxed criteria for entry and continuation in treatment may not be as effective as the traditional, specialist methadone clinics. A proposal to commence dispensing methadone to a population of young, "at risk" opiate injectors at a primary health care centre in Kings Cross, Sydney afforded the opportunity to evaluate a methadone program similar to those operating in The Netherlands. The key question posed by this evaluation was: Does methadone maintenance treatment, when integrated into an exisiting primary health care centre, help young, "at-risk" injecting opiate users to reduce their heroin use, crime, HIV risk behaviour and to improve their health? In order to answer this question, 70 applicants for treatment were randomised to receive methadone or not in addition to the usual care they had been receiving at the clinic and were assessed at intake and three months later. A series of analyses were performed in order to adjust for selective attrition between the two groups at three-month follow-up and to assess the influence of exposure to methadone treatment in the control group. These analyses indicated that exposure to methadone maintenance is associated with reductions in heroin use, crime and HIV risk behaviour, as well as improvements in health. Thus, it can be concluded that methadone maintenance is of benefit to young, "at risk" opiate injectors. This suggests that methadone maintenance services should be modified and expanded to attract a wider range of opioid dependent individuals into treatment, especially those more at risk and who find it difficult to comply with the protocols of the more traditional clinic regimen.