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Review: methadone increases retention and reduces heroin use compared with non-pharmacological maintenance

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Question

Question:

Does methadone maintenance treatment (MMT) reduce opioid dependence more than treatments not involving opioid replacement therapy?

Outcomes:

Primary outcomes: retention in treatment, mortality, proportion of urine or hair analysis results positive for heroin or morphine, self-reported heroin use, criminal activity. Secondary outcomes: use of other drugs, physical health, psychological health.

Methods

Design:

Systematic review with meta-analysis.

Data sources:

Cochrane Drugs and Alcohol Group Register of Trials (issue 4, 2008), PUBMED, EMBASE, Current Contents, PsycLIT and CINAHL were searched to December 2008. Other drug specific databases, ongoing trial registers, drug and alcohol journals, conference proceedings and reference lists were also searched.

Study selection and analysis:

Two reviewers independently selected and quality assessed randomised controlled trials of MMT compared with placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. Inclusion criteria: people who were opioid dependent (heroin or methadone); trials of MMT alone or with behavioural therapies or outpatient rehabilitation compared with placebo, withdrawal or detoxification (with or without ancillary medication), drug free rehabilitation treatments (such as therapeutic communities) and no treatment or waiting list controls. …

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