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Heroin Addiction and Related Clinical Problems: 2008, 10, 2 (pages: 27 - 38)

GPs' office based Metadone Maintenance Treatment in Trieste, Italy.Therapeutic efficacy and predictors of clinical response

Michelazzi A., Vecchiet F., Leprini R., Popovic D., Deltito J., Maremmani I.

Summary: Objective: To evaluate the effectiveness of methadone treatment carried out by General Practitioners (GPs) and to identify response treatment factors. Methods: 33 subjects with heroin addiction according to the DSM-IV-R criteria , 25 males and 8 females with an average age of 26 ± 6 years, were placed in an observational protocol with average duration of 429 ± 273 days. Retention rate, substance use, overall clinical improvement, social adaptation, quality of life and psychopathologic symptoms were used as outcome measures. In order to assess predictors of treatment response dropout and non-dropout subjects were compared at baseline. Results: At the end of the observational period, 6 patients (18.2%) had a positive outcome, 8 (24.2%) negative outcome, while 19 (57.6%) were still in treatment with a cumulative retention of 60% at the end of the third year of observation. In 25 non-dropout patients baseline-endpoint improvement results were statistically significant for substance use, global clinical evaluation, psychological, social and occupational functioning, and craving. They also showed improvement in all of investigated psychopathological and quality of life dimensions. There were no significant side effects associated with their treatment. Patients with higher severity of illness, with problematic relationships with spouse/partner, difficulty with socialization and organization of leisure, with an altered mental state at beginning of treatment, subjects with dual diagnosis (especially bipolar disorder), with greater severity of obsessive-compulsive symptoms, interpersonal sensitivity, depression, violence, with greater severity of psychopathological symptoms, with the largest number of problematic areas as regarding the quality of life, patients with a low dose of methadone given for treatment were considered most at risk for abandoning treatment. Conclusions: Methadone treatment carried out by General Practitioners appears safe and effective, especially in less severe patients treated with adequate doses, without severe psychopathology, without dual diagnoses (particularly bipolar disorder) and with quality of life impairment only in limited areas.