Dosage Patterns in Methadone Treatment: Results from a National Survey, 1988–2005

Authors

  • Harold A. Pollack,

    1. Faculty Chair, Center for Health Administration Studies, University of Chicago, 969 East 60th St., Chicago, IL 60637
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    • Address correspondence to Harold A. Pollack, M.P.P., Ph.D., Associate Professor of Social Service Administration, Faculty Chair, Center for Health Administration Studies, University of Chicago, 969 East 60th St., Chicago, IL 60637; e-mail: haroldp@uchicago.edu. Thomas D'Aunno, Ph.D., is with INSEAD, Boulevard de Constance, 77305 Fontainebleau Cedex, France.

  • Thomas D'Aunno

    1. INSEAD, Boulevard de Constance, 77305 Fontainebleau Cedex, France
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Abstract

Objective. To examine the extent to which U.S. methadone maintenance facilities meet established standards for minimum dosages, 1988–2005.

Data Source. Data were collected from a nationally representative sample of outpatient treatment facilities in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), and 2005 (n=146).

Study Design. Random-effects multiple regression analysis was used to examine unit characteristics associated with below recommended doses.

Data Collection. Data regarding the proportion of patients who received maintenance dosages of <40, 60, and 80 mg/day were collected from unit directors and clinical supervisors.

Principal Findings. Forty-four percent of patients receive doses of at least 80 mg/day—the threshold identified as recommended practice in recent work. Thirty-four percent of patients receive doses below 60 mg/day, while 17 percent receive doses below 40 mg/day. Units that serve a high proportion of African American or Latino clients were more likely to report low-dose care. Units managed by individuals who strongly favor abstinence models (e.g., Narcotics Anonymous) were more likely to provide low-dose care.

Conclusions. One-third of methadone facilities provide doses below recommended levels. Managerial attitudes about abstinence and their relationship to low doses underscore the contested role of methadone in treatment of opiate disorders.

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