HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2016, 18, N5 (pages: 5 - 14)

Evaluating Methadone Maintenance Treatment. The Sant'arsenio Methadone Clinic, in the Vallo Di Diano Region (Italy), as Case Study

Mautone S., Maremmani A.G., Gazzarrini D., and Maremmani I.

Summary: Introduction: The correspondence between scientific knowledge and healthcare practices is essential to meeting the need to provide Heroin Use Disorder (HUD) patients with qualitative improvements in well-functioning methadone clinics. Methods: In our search to identify quality control requirements, we evaluated, in January 2010, and again in January 2012, the outcomes of all patients registered in the methadone clinic of Sant'Arsenio, Salerno, Italy, in which Dole and Nyswander methodology is strictly applied. Out of 212 evaluated heroin-dependent patients, 85 had only the January 2010 evaluation (patients leaving treatment), 103 had both assessments (patients staying in treatment) and 24 had only the January 2012 evaluation (patients entering treatment). Results: In all the patients investigated, medical outcomes were positive. In general, patients leaving a treatment were older than patients entering one (p=0.028). Patients entering treatment showed a lower percentage of working people than patients staying in treatment ones (p=0.002), were more often at first treatment (p=0.008) and showed a more severe illness than their peers (p=0.002), and were still using CNS depressants more frequently (p=0.009). Patients staying in treatment more often declared an adequate income (p=0.049); at the follow-up 2 years later, there was a significant improvement in the frequency of people leaving their parents' family (p=0.001), in numbers of people presenting only a mild psychopathology (p<0.001), in achieving the status of being without legal problems (p=0.021), and in having reduced cannabinoid use (p=0.019). They did not show any significant differences in changes in the severity of illness (0.118), global improvement (p=0.508) or the therapeutic/side effect index (p=0.481). Conclusions: We propose three simple requirements in assessing the quality control of a methadone clinic: (1) HUD patients leaving the treatment must have obtained similar results to those of stabilized patients staying in treatment. (2) HUD patients staying in treatment must be able to show an improvement in outcome, if there is a follow-up scheduled at least biannually. (3) HUD patients entering treatment must have had only very limited previous treatment, and they must be younger than patients leaving treatment.