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Consistent Adherence To Guidelines Improves Opioid Dependent Patients’ First Year Outcomes

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Abstract

Clinical practice guidelines for opioid substitution treatment (OST) for opioid dependence recommend that patients receive at least 60 mg daily methadone and have access to a broad array of psychosocial services. However, there is still wide variation in clinical practice in OST clinics. In real-world settings, patients could receive lower methadone doses and less psychosocial care because they require less intensive care for recovery; alternatively, barriers to delivery of guideline concordant care could limit treatment received and impair recovery. The Multisite Opioid Substitution Treatment (MOST) study examines the impact of more consistent adherence to guideline recommendations in eight Veterans Affairs OST clinics. While patients at all clinics demonstrated improvements in substance use over the first year in treatment, patients at clinics that more consistently adhered to guidelines had greater reductions in heroin and cocaine use and greater improvement in mental health. These results suggest that efforts to increase guideline adherence in OST will improve patient outcomes.

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Acknowledgments

This study was funded by grants SUS 99-026 and RCS 04-141-01 to K.H, MRP 02-260-1 to JT, and MRP 05-168-1 to AH from the Department of Veterans Affairs Health Services Research and Development (VA HSR&D) Service. We thank Doyanne Horst, Jared Minkel, and the clinicians at all participating sites for assistance with data collection.

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Authors and Affiliations

  1. Center for Health Care Evaluation, Veterans Affairs and Stanford University Medical Centers, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Jodie A. Trafton PhD, Keith Humphreys PhD & Alex H. S. Harris PhD

  2. Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305, USA

    Jodie A. Trafton PhD & Keith Humphreys PhD

  3. Developmental Psychopathology and Clinical Science, University of Minnesota Institute of Child Development, 51 East River Road, Room 210, Minneapolis, MN, 55455-0345, USA

    Elizabeth Oliva M.A.

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  1. Jodie A. Trafton PhD
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  2. Keith Humphreys PhD
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  3. Alex H. S. Harris PhD
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  4. Elizabeth Oliva M.A.
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Correspondence to Jodie A. Trafton PhD.

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Trafton, J.A., Humphreys, K., Harris, A.H.S. et al. Consistent Adherence To Guidelines Improves Opioid Dependent Patients’ First Year Outcomes. J Behav Health Serv Res 34, 260–271 (2007). https://doi.org/10.1007/s11414-007-9074-2

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  • DOI: https://doi.org/10.1007/s11414-007-9074-2

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