• Crime;
  • heroin;
  • methadone;
  • methadone maintenance treatment;
  • MMT;
  • primary care


Background  Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations.

Aims  To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service.

Design  Cohort study.

Setting  The primary care clinic for drug dependence, Sheffield, 1999–2005.

Participants  The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years.

Intervention  The intervention consisted of MMT provided by GPs in a primary care clinic setting.

Measurements  Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records.

Findings  The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment.

Conclusions  MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions.