Client characteristics and experiences in three methadone maintainance therapy models

Abstract

Methadone Maintenance Therapy (MMT) is the most common form of substitution therapy for opioid use disorder in New Brunswick. Results from systematic reviews indicate that MMT is a cost-effective treatment and is associated with improved outcomes. Although methadone dispensation is the primary component of MMT, several aspects of these programs differ depending on the treatment model. This variation has not been the focus of empirical research. The current study used a mixed-method design to assess client characteristics and experiences in three MMT treatment delivery models: 1) comprehensive programs which combine methadone treatment with mandatory physician appointments and counselling, 2) low-threshold-high- tolerance (LTHT) programs which focus on stabilization on methadone and offer primary healthcare services, and 3) fee-for-service methadone programs which are run by community pharmacies and where the dispensation of methadone is the core component. Seventy participants were recruited from five treatment sites in Saint John, New Brunswick and grouped based on model of care: Comprehensive program (n = 21), LTHT program (n = 26), and fee-for-service program (n = 23). Self-report questionnaires were used to collect data on demographics, substance use, personality, and treatment readiness. A semi-structured interview examining client history, progress in treatment, perception of treatment programs, and ancillary services was administered to a subset of these participants (n = 31). A series of one-way ANOVA tests examined group differences in substance use, personality, and treatment readiness. Results indicated that participants in the fee-for-service group reported higher levels of substance use severity and polysubstance use than participants in the comprehensive and LTHT groups. Content analysis was performed on interview data to assess the frequency of relevant themes in the qualitative data. The most prominent themes included: wanting supportive staff; wanting more structured counselling; and, desiring more consistency/organization of services. These findings have important implications for the implementation of MMT, as this study suggests that fee-for-service models of MMT may not be as effective in reducing substance use as more traditional service delivery models. In addition, the availability and quality of mental health services should be reviewed and integration between addiction services and mental health services should be emphasized.