Eyes Wide Shut? – A Conceptual and Empirical Critique of Methadone Maintenance Treatment

Vol. 11, No. 1, 2005

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Research Report

Eyes Wide Shut? - A Conceptual and Empirical Critique of Methadone Maintenance Treatment
Benedikt Fischer^{a, b}, Jürgen Rehm^{a, b,c}, Gregory Kim^{a, b}, Maritt Kirst^b

^aUniversity of Toronto,
^bCentre for Addiction and Mental Health, Toronto, Canada;
^cAddiction Research Institute, Zurich, Switzerland

Address of Corresponding Author

Eur Addict Res 2005;11:1-14 (DOI: 10.1159/000081410)

Key Words

Opioid dependence
Methadone maintenance treatment
Treatment evaluation
Quality of life
Self-medication

Abstract

Background: Methadone maintenance treatment (MMT) has been the 'gold standard' pharmacotherapy treatment for illicit opioid dependence for over 30 years. It has been widely evaluated, and is generally claimed to be 'effective'. Methods: The objective of this paper is to review the rationale of MMT as an intervention for a biomedical disorder with primary social objectives as well as the methodological quality and evidence of MMT outcome research. Data sources included opioid dependence treatment practice, review and outcome research literature (1965-2001) in the form of peer-reviewed articles, books, monographs and reports that are preeminently cited and reviewed international studies on MMT. Results/Data Synthesis: Rigorous and appropriate evaluation (i.e., RCTs, intent-to-treat, patient-centered) methods in MMT evaluations are rare. Evidence of MMT's effectiveness on primary treatment objectives is mixed and appears to be largely partial and short-term. Positive outcomes may be the result of selection effects of compliant patients and loss in proportion when more rigorous standards of analysis are applied. Conclusions: The quality of existing MMT research, and evidence for its general effectiveness are limited. Key concepts of self-medication and psychiatric comorbidity are largely ignored in MMT treatment and research frameworks, although they may serve to explain MMT's limited treatment success. Emerging new opioid pharmacotherapies require the fundamental review of the existing MMT paradigm as well as the application of rigorous and appropriate evaluation methods for future treatment.

Author Contacts

Benedikt Fischer, PhD
Department of Public Health Sciences, University of Toronto
McMurrich Bldg., 109C, Toronto, Ont., M5S 1A8 (Canada)
Tel. +1 416 535 8501, Fax +1 416 260 4156
E-Mail benedikt.fischer@utoronto.ca

Article Information

Number of Print Pages : 14
Number of Figures : 0, Number of Tables : 0, Number of References : 92

Medline Abstract (ID 15608466)

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