Federal Regulation of Methadone Treatment (1995) / Chapter Skim
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Who Are the Recipients of Treatment?
Who Are the Recipients of Treatment?
Pages 61-91
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From page 61... ...
How persistent is heroin addiction if untreated? How likely are heroin addicts to seek treatment?
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From page 62... ...
These are the addicts for whom methadone treatment is intended, treatment that has given rise to the methadone regulations. Although they represent a relatively small percentage of the total users of opiates, addicts constitute a large absolute number who contribute disportionately to drug-related crime and threats to the public health.
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From page 63... ...
We discuss below some findings from epidemiologic studies that put upper bounds on the number of addicts in the population. Available epidemiological data on heroin use and dependence, coupled with data from other sources about the addict population, provide a background for placing methadone treatment in context and answering a number of specific questions that affect the committee's charge.
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From page 64... ...
. Another important epidemiological study of drug use is the National Household Survey, which interviews persor~s 12 years old and older in a national sample of household residents every year or two.
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From page 65... ...
Finally, in the recent National Comorbidity Study, 8,098 household residents aged 15-54 were asked if they had ever used heroin even once; one percent had used, and only 23 percent of users qualified as ever dependent according to DSM-III-R criteria (NCS, 1994~. The last two studies, which are studies of the general
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From page 66... ...
Although most heroin addicts use injection into the vein as their method of ingestion, the quality of heroin in some areas of the country is now high enough to allow smoking or snorting as a route of administration, thus removing a major barrier to heroin use. These changes may lead to both an increase in users and a higher probability that users will become addicted.
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From page 67... ...
The Hser findings were similar to those of the other two studies, which found that death, incarceration, or continued addiction was the course of the majority of addicts identified in treatment or criminal justice settings. Once heroin addiction is established, in many cases even for a relatively short period, it tends to persist and most addicts relapse repeatedly.
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From page 68... ...
In 1992, the National Comorbidity Study found the relationship had reversed there were over 6 times as many cocaine users as heroin users. These results suggest that heroin-addicted persons in treatment will have dependencies on a variety of other substances and that problems with drugs other than heroin may be as responsible as heroin for their distress and maladjustment.
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From page 69... ...
Thus, dependent persons, and certainly heroin addicts among them, appear to be a particularly medically underserved population. Heroin-dependent persons have a number of social problems, including difficulty in holding jobs, obeying laws, maintaining stable marriages, making
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From page 70... ...
For example, there was frequently a childhood and early adolescent history of school problems and truancy, delinquency, drinking, lying, running away from home, and fighting. The fact that these early behaviors predict adult social problems independent of drug dependence means that once the heroin addiction is controlled through methadone treatment, the addict's social problems are likely to decline but not vanish.
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From page 71... ...
The first study, the NADR study, included a fairly large subsample of primary heroin addicts (about 16,500) accessed through nontraditional access mechanisms (he., they were not drawn from treatment programs or criminal justice populations)
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From page 72... ...
In contrast to the no-treatment-history group, those with a treatment history, particularly those with a methadone maintenance history, report more prior contact with the criminal justice system and have longer reported years of addiction. The methadone group reports higher rates of prior treatment than the nonmethdone treatment group.
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From page 73... ...
METHADONE PATIENT CHARACTERISTICS The following section presents data on historical tends and current characteristics of those heroin addicts now in methadone maintenance treatment. We examine most closely methadone maintenance clients, and briefly describe methadone detoxification clients.
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From page 74... ...
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From page 75... ...
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From page 76... ...
Generally, patients entering methadone maintenance treatment are dysfunctional in a number of behavioral domains, show long
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From page 77... ...
The CDS is based upon admissions data on methadone patients in treatment programs as reported by 31 of the 42 reporting states. (During 1992, as discussed earlier and shown on Table 3-2, 26 states reported admission for methadone maintenance treatment.
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From page 80... ...
Five of the reporting jurisdictions (California, District of Columbia, New Jersey, New York, and Rhode Island) predominate in the methadone maintenance treatment data, each accounting for more than 10 percent of the nation's methadone treatment admissions.
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From page 81... ...
Contrast Between Detoxification and Maintenance Patient Admissions Characteristics of detoxification and maintenance patient admissions are similar, except in the following areas: There are more repeaters among those detoxified, where 42 percent reported 5 or more prior treatment episodes compared to 19 percent for methadone maintenance admissions. Referrals by the criminal justice system account for a smaller proportion of detoxification admissions (1 percent)
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From page 82... ...
To provide more detailed information on the use of methadone in maintenance treatment, we present data from two states with large maintenance populations, New York and California. Maintenance Patients in New York State; 1992 Some one-third of the methadone maintenance treatment population of the United States is in New Yorlc State programs.
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From page 83... ...
Maintenance Patients in California, 1992 The California Alcohol and Drug Data System (CADDS) contains data from all methadone treatment programs except those in Department of Veterans Affairs hospitals.
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From page 84... ...
Detoxification admissions report fewer prior treatment episodes than do maintenance admissions. The differences are due, in part, to state regulations that require at least two prior treatment failures for maintenance admissions, but not for detoxification admissions.
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From page 85... ...
New York State and its local governments subsidize the majority of methadone maintenance treatment programs and have few restrictions on dosing or duration of treatment. It was in New York City that the pioneering research of Dole and Nyswander (see, e.g., Dole and Nyswander, 1965)
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From page 86... ...
Independently, as local government budgets were constrained in 1976 and thereafter as a result of Proposition 13, many California counties began to withdraw their subsidy of methadone maintenance treatment programs. By the mid-1980s, the majority of methadone treatment funds were provided out-ofpocket by clients' fees (see chapter 6~.
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From page 88... ...
reviewed the literature regarding the prevalence of heroin addiction and concluded: "Since the HPI tHeroin Problems Indexi-based estimate in 1981, there has been only one formal estimate of the number of heroin addicts nationally (Cooley et al.
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From page 89... ...
3It should be noted that the incarcerated population includes a considerable number of heroin addicts who are unable to participate in methadone treatment programs.
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From page 90... ...
1994. Client Characteristics Among Admissions to Methadone Treatment Programs in Two National Samples: 1979-981, 1991-993.
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From page 91... ...
1989. On the accuracy of estimates of numbers of intravenous drug users.
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