As a result of inadequate funding for treatment, waiting lists for opioid treatment programs (OTPs) persist, and new and more effective approaches for expanding treatment access and improving outcomes are needed. This competing renewal application seeks to build on our parent R01 study, which was the first randomized clinical trial of interim methadone treatment conducted under existing federal regulations. Research resulting from the parent study has demonstrated that interim treatment (methadone with only crisis counseling) in comparison to wait list control, was associated with greater entry into comprehensive OTPs, lower self-reported heroin and cocaine use, lower rates of opioid-positive drug tests, and lower rates of self-reported crime at both 4- and 10- month follow-up (Schwartz et al., 2006 and in press). A parallel two-group randomized study is proposed, in which adult heroin-dependent subjects (N = 300) who meet federal criteria for OTP entry and for whom no treatment slot is available, will be randomly assigned at three community-based OTPs to either interim methadone treatment or prompt admission to comprehensive methadone treatment. Following federal guidelines, all interim treatment subjects who have not gained entry into a comprehensive OTP by 120 days (4 months) from study entry will be admitted to comprehensive treatment. Outcome will be assessed by measuring enrollment in comprehensive treatment at 4 and 12 months from baseline, as well as participants'illicit drug use, HIV-risk behavior, and criminal activity at baseline and at 2, 4, and 12 months post-baseline. We hypothesize that prompt entry to comprehensive treatment will have outcomes superior to interim treatment. Furthermore, participants with lower motivation for treatment are hypothesized to respond more positively to interim maintenance than to comprehensive treatment, because of potentially aversive features of comprehensive treatment, particularly confrontation in counseling. Finally, a cost benefit analysis will be conducted to determine the related costs and benefits of interim treatment v. comprehensive treatment. The results of this study will provide important information to researchers, clinicians, and public health policymakers regarding the relative effectiveness and benefits of these two approaches to OTP treatment.
| Schwartz, Robert P; Alexandre, Pierre K; Kelly, Sharon M et al. (2014) Interim versus standard methadone treatment: a benefit-cost analysis. J Subst Abuse Treat 46:306-14 |
| Kelly, Sharon M; Oýýgrady, Kevin E; Jaffe, Jerome H et al. (2013) Improvements in outcomes in methadone patients on probation/parole regardless of counseling early in treatment. J Addict Med 7:133-8 |
| Gryczynski, Jan; Mitchell, Shannon Gwin; Jaffe, Jerome H et al. (2013) Retention in methadone and buprenorphine treatment among African Americans. J Subst Abuse Treat 45:287-92 |
| Kelly, Sharon M; Schwartz, Robert P; Oýýgrady, Kevin E et al. (2012) Impact of methadone with versus without drug abuse counseling on HIV risk: 4- and 12-month findings from a clinical trial. J Addict Med 6:145-52 |
| Mitchell, Shannon Gwin; Kelly, Sharon M; Gryczynski, Jan et al. (2012) African American patients seeking treatment in the public sector: characteristics of buprenorphine vs. methadone patients. Drug Alcohol Depend 122:55-60 |
| Schwartz, Robert P; Kelly, Sharon M; O'Grady, Kevin E et al. (2012) Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. Addiction 107:943-52 |
| Gryczynski, Jan; Schwartz, Robert P; Salkever, David S et al. (2011) Patterns in admission delays to outpatient methadone treatment in the United States. J Subst Abuse Treat 41:431-9 |
| Schwartz, Robert P; Kelly, Sharon M; O'Grady, Kevin E et al. (2011) Interim methadone treatment compared to standard methadone treatment: 4-month findings. J Subst Abuse Treat 41:21-9 |
| Wilson, Monique E; Schwartz, Robert P; O'Grady, Kevin E et al. (2010) Impact of interim methadone maintenance on HIV risk behaviors. J Urban Health 87:586-91 |
| Schwartz, Robert P; Jaffe, Jerome H; O'Grady, Kevin E et al. (2009) Scaling-up interim methadone maintenance: treatment for 1,000 heroin-addicted individuals. J Subst Abuse Treat 37:362-7 |
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