Reengineering Methadone Treatment: A Clinical Trial

Principal Investigator: Robert Schwartz, M.D.
Co-Investigator: Jerome H. Jaffe, M.D.
Co-Investigator: Shannon Gwin Mitchell, Ph.D.
Funded By: National Institute on Drug Abuse
Grant #: 2 RO1 DA 015842
Total Project Period: 3/1/11 – 2/28/15

Premature discontinuation from methadone treatment programs (MTP) is a frequent occurrence and is associated with continued illicit drug use, HIV infection, overdose death, and crime. This NIDA-funded study builds on the findings of our parent grant (5R01DA 015842) in which nearly half of over 350 newly admitted MTP were no longer in treatment at 12-month follow-up, in large part because of the powerful influence of program rules and the role of the counselor as enforcer of the rules. Our goal is to test the impact of a fundamental re-engineering of MTPs, based on the conceptual model of patient-centered care in order to avoid premature drop-out and to improve patient outcomes.

The Patient-Centered Methadone Program (PC-MTP) will reorganize the staff roles and MTP rules such that counselors will not be responsible for enforcing the clinics’ rules for their patients, patients will be encouraged but not required to participate in counseling, and most clinic rule infractions will result in consequences short of “administrative” discharge. This two-site randomized clinical trial with 300 participants will compare, on an intent-to-treat basis, the relative effectiveness of PC-MTP to treatment-as-usual MTP over the course of 12 months of treatment.