Skip to main content

Advertisement

Log in

Longitudinal Effects of LAAM and Methadone Maintenance on Heroin Addict Behavior

  • Special Issue
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Levo-alpha-acetylmethadol maintenance (LAAM) was compared to methadone maintenance (MM) on the behavioral performance of 315 heroin addicts before, during, and after 12 months of fully subsidized treatment. Assessments of drug use, criminal behavior, HIV risk behaviors, and employment and residential status were obtained at treatment intake and at 6, 12, and 18 months after admission. Treatment retention and in-treatment suppression of heroin use were significantly better for the LAAM group than for the MM group. Improvements were also noted during treatment in criminal behavior, criminal justice involvement, and employment status, and there were reductions in injection HIV risk and number of sexual partners. Most significant effects were primarily related to active participation in maintenance treatment. Under subsidized treatment, retention rates were two to four times that of similar clients in local community programs during the same period. LAAM was a useful and a potentially important addition to treatment options for opiate addiction, conferring greater retention and opiate suppression benefits. Its removal from application provides a historical lesson concerning the introduction of new medications into addiction health services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ball J, Ross A. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. New York: Springer; 1991.

    Google Scholar 

  2. Marsch L. The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction. 1998;93:515–532, doi:10.1046/j.1360-0443.1998.9345157.x.

    Article  PubMed  CAS  Google Scholar 

  3. US Food and Drug Administration (FDA). LAAM Approved to Treat Drug Dependence. Talk Paper T93-36. August 3, 1993. Available at: http://www.fda.gov/bbs/topics/ANSWERS/ANS00517.html. Accessed February 14, 2008.

  4. Vocci FJ, Acri J, Elkashef A. Medication development for addictive disorders: the state of the science. American Journal of Psychiatry. 2005;162:1432–1440, doi:10.1176/appi.ajp.162.8.1432.

    Article  PubMed  Google Scholar 

  5. Longshore D, Annon J, Anglin MD, et al. Levo-alpha-acetylmethadol (LAAM) versus methadone: treatment retention and opiate use. Addiction. 2005;100:1131–1139, doi:10.1111/j.1360-0443.2005.01122.x.

    Article  PubMed  Google Scholar 

  6. Anglin MD, Conner BT, Annon J, et al. Levo-alpha-acetylmethadol (LAAM) versus methadone maintenance: one-year treatment retention, outcomes, and status. Addiction. 2007;102:1432–1442, doi:10.1111/j.1360-0443.2007.01935.x.

    Article  PubMed  Google Scholar 

  7. Newcombe D, Bochner F, White J, et al. Evaluation of levo-alpha-acetylmethadol (LAAM) as an alternative treatment for methadone maintenance patients who regularly experience withdrawal: a pharmacokinetic and pharmacodynamic analysis. Drug and Alcohol Dependence. 2004;76:63–72, doi:10.1016/j.drugalcdep.2004.04.004.

    Article  PubMed  CAS  Google Scholar 

  8. Fischer B, Rehm J, Kim G, et al. Eyes wide shut: a conceptual and empirical critique of methadone maintenance treatment. European Addiction Research. 2005;11:1–14, doi:10.1159/000081410.

    Article  PubMed  CAS  Google Scholar 

  9. Anglin MD. Conversation with M. Douglas Anglin. Addiction. 2006;101:169–180, doi:10.1111/j.1360-0443.2006.01318.x.

    Article  PubMed  Google Scholar 

  10. Villafranca S, McKellar J, Trafton J, et al. Predictors of retention in methadone programs: a signal detection analysis. Drug and Alcohol Dependence. 2006;83:218–224, doi:10.1016/j.drugalcdep.2005.11.020.

    Article  PubMed  Google Scholar 

  11. Anglin MD, McGlothlin WH. Methadone maintenance in California: a decade’s experience. In: Brill L, Winick C, eds. The Yearbook of Substance Use and Abuse. Vol. III. New York: Humana Sciences; 1985:219–280.

    Google Scholar 

  12. Anglin MD, Perrochet B. Drug use and crime: a historical review of research conducted by the UCLA Drug Abuse Research Center. Substance Use and Misuse. 1998;33:1871–1914.

    Article  PubMed  CAS  Google Scholar 

  13. Anglin MD, Powers KI. Methadone treatment and legal supervision: individual and joint effects on the behavior of narcotics addicts. Journal of Applied Behavioral Science. 1991;27:515–531, doi:10.1177/0021886391274009.

    Article  Google Scholar 

  14. Powers KI, Anglin MD. A differential assessment of the cumulative versus stabilizing effect of methadone maintenance treatment. Evaluation Review. 1998;22:175–206, doi:10.1177/0193841X9802200202.

    Article  PubMed  CAS  Google Scholar 

  15. Longshore DL, Hsieh S, Danila B, et al. Methadone maintenance and needle/syringe sharing. International Journal of the Addictions. 1993;28:983–996.

    PubMed  CAS  Google Scholar 

  16. Grella CE, Anglin MD, Wugalter SW, et al. The effectiveness of the Los Angeles Enhanced Methadone Maintenance Project: reducing HIV risk among injection drug users. In: Tims FM, Inciardi JA, Fletcher W, et al, eds. The Effectiveness of Innovative Approaches in the Treatment of Drug Abuse. Westport, CT: Greenwood; 1997:17–32.

    Google Scholar 

  17. Lott D, Strain E, Bronner R, et al. HIV risk behavior during pharmacologic treatment for opioid dependence: a comparison of levomethadyl acetate, buprenorphine, and methadone. Journal of Substance Abuse Treatment. 2006;31:187–194, doi:10.1016/j.jsat.2006.04.005.

    Article  PubMed  Google Scholar 

  18. Longshore D, Hsieh S, Anglin MD. Reducing HIV risk behavior among injection drug users: effect of methadone maintenance treatment on number of sex partners. International Journal of the Addictions. 1994;29:741–757.

    PubMed  CAS  Google Scholar 

  19. Grella CE, Anglin MD, Annon JJ. HIV risk behaviors among women in methadone maintenance treatment. Substance Use and Misuse. 1996;31:277–301, doi:10.3109/10826089609045813.

    Article  PubMed  CAS  Google Scholar 

  20. Jaffe JH. Can LAAM, like Lazarus, come back from the dead? Addiction. 2007;102(9):1342–1343, doi:10.1111/j.1360-0443.2007.01976.x.

    Article  PubMed  Google Scholar 

  21. Grella C, Anglin M, Rawson R, et al. What happens when a demonstration project ends: consequences for a clinic and its clients. Journal of Substance Abuse Treatment. 1996;12:249–256, doi:10.1016/S0740-5472(96)00055-4.

    Article  Google Scholar 

  22. Los Angeles County Participant Reporting System (LACPRS). Los Angeles County Department of Public Health, Alcohol and Drug Program Administration, FYs 1996–97, 1997–98, 1998–99. Web site: http://www.lapublichealth.org/index.htm.

  23. SPSS, Inc. SPSS for Windows. Release 14.0. Chicago: SPSS Inc., 2005.

  24. Tims F, Inciardi J, Fletcher B, et al. The Effectiveness of Innovative Approaches in the Treatment of Drug Abuse. Westport, CT: Greenwood; 1997.

    Google Scholar 

  25. Binswanger I, Stern M, Deyo R, et al. Release from prison—a high risk of death for former inmates. New England Journal of Medicine. 2007;356(2):157–165, doi:10.1056/NEJMsa064115.

    Article  PubMed  CAS  Google Scholar 

  26. Christensen P, Brehm H, Smith E, et al. Mortality among Danish drug users released from prison. International Journal of Prisoner Health. 2006;2(1):13–19, doi:10.1080/17449200600743644.

    Article  Google Scholar 

  27. Smyth B, Hoffman V, Fan J, et al. Years of potential life lost among heroin addicts 33 years after treatment. Preventive Medicine. 2007;44(4):369–374, doi:10.1016/j.ypmed.2006.10.003.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Data collection and analysis were supported by grant R01 DA10422 from the National Institute on Drug Abuse. Dr. Anglin is also supported by NIDA Senior Research Scientist Award K05 DA00146. The authors wish to thank Gerhard Hellemann, Ph.D. for his assistance in statistical analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Douglas Anglin PhD.

Additional information

Douglas Longshore died December 2005.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anglin, M.D., Conner, B.T., Annon, J.J. et al. Longitudinal Effects of LAAM and Methadone Maintenance on Heroin Addict Behavior. J Behav Health Serv Res 36, 267–282 (2009). https://doi.org/10.1007/s11414-008-9155-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-008-9155-x

Keywords

Navigation