The Research Outcome Study in Ireland (ROSIE) is a national multi-site drug treatment outcome study which is being conducted by a team at the National University of Ireland, Maynooth, on behalf of the National Advisory Committee on Drugs (NACD).  The aim of the study is to recruit and follow opiate users entering treatment and to document their progress after six months, one year and three years.

At baseline, the study recruited 404 opiate users aged 18 years or over entering treatment or, in the case of a sub-sample of 26 (6%), attending needle-exchange services.  The participants were engaged in one of three different forms of treatment: methadone maintenance/reduction (53%, n=215), structured detoxification (20%, n=81) and abstinence-based treatment (20%, n=82). 

The treatment outcomes presented in the first three papers in the ROSIE Findings series have been reported in previous issues of Drugnet Ireland.  The fourth paper in the series, ROSIE Findings 4,1 provides a summary of the outcomes for people in the methadone modality one year after treatment intake.  

The provision of methadone, a long-acting opiate agonist, under medical supervision is the main pharmacological substitution intervention for opiate users in Ireland.  Initially, a low commencing dose (usually 10–40 ml) is prescribed, aimed at achieving a level of comfort while reducing the likelihood of overdose.  By the end of six weeks’ treatment, the individual is usually stabilised on an appropriate therapeutic dose.  Methadone maintenance is a long-term treatment option of no fixed duration and there are different models of maintenance prescribing, ranging from highly structured regimes to low-threshold programmes. 

The ROSIE study methadone cohort (n=215) was recruited from health board clinics (50%, n=108), general practitioners (25%, n=54), community-based clinics (22%, n=48) and prison (2%, n=5).  The analysis presented in Findings 4 is based on the 167 (78%) participants who provided valid answers to each individual question during their treatment intake and one-year follow-up interviews. 

Participants in the methadone modality were typically male (68%), with an average age of 28 years, and were largely dependant on social welfare payments (81%).  The majority (64%) had children aged under 18 years.  Sixty per cent had spent time in prison and 17% had been homeless in the 90 days prior to treatment intake interview.  

Treatment completion rates

Methadone is a long-term treatment option and, at one year, 3% (n=5) had completed treatment.  The retention rate was high: 79% (n=132) were still receiving methadone treatment at one year, 6% (n=10) had transferred to another treatment modality and 12% (n=20) had dropped out of treatment. 

One year after treatment intake, 90% (n=151) reported being in some form of drug treatment.  Eighty-four per cent (n=141) were in methadone treatment, 26% (n=44) were attending one-to-one counselling, 15% (n=25) were in group work (Narcotics Anonymous meetings, aftercare programmes, and Community Employment schemes), and 1% (n=2) were in a structured detoxification programme. 

Drug use outcomes

The number of participants who reported using heroin, non-prescribed methadone, non-prescribed benzodiazepines, cocaine powder or crack cocaine in the 90 days prior to interview decreased between treatment intake and one-year follow-up.  The most substantial reduction was in opiate use (heroin and non-prescribed methadone) both in terms of the proportion of participants using the drug and the frequency of use.  Heroin use decreased from 84% at treatment intake to 53% at one year, while non-prescribed methadone use decreased from 48% to 16%.  The frequency of heroin use decreased from 50 days out of 90 at treatment intake to 15 days out of 90 at one year, while the frequency of non-prescribed methadone use decreased from 16 days out of 90 at treatment intake to 4 days out of 90 at one year. 

Polydrug use in the 90 days prior to interview also reduced, from 78% (n=131) at treatment intake to 56% (n=94) at one year.  At one-year follow-up, 16% (n=27) of participants reported that they had not used any illicit drugs in the 90 days prior to interview. 

Crime outcomes

Overall, the proportion of participants who reported involvement in crime had decreased from 49% at treatment intake to 27% at one year.  There was a reduction in the percentage of participants involved in acquisitive crime, from 28% at treatment intake to 15% at one year.  

Risk behaviour outcomes

There was a significant reduction in the number of participants who reported injecting drug use.  At treatment intake, 44% (n=73) had injected a drug in the 90 days prior to interview, compared with 32% (n=53) at one year.  There were no changes in participants’ injecting-related risk behaviours.  There was a non-significant reduction in the proportion of participants who reported an overdose in the 90 days prior to interview, from 8% (n=12) at treatment intake to 6% (n=9) at one year.

Health outcomes

Ten symptoms were used to measure the physical health of participants (see paper for details).  The number of participants who reported nine of the ten physical health symptoms increased between treatment intake and one year, with a significant increase observed in the proportion reporting stomach pains. 

Ten symptoms were also used to measure the mental health of participants (see paper for details).  There was an increase in the number of participants who reported suffering from any six of the ten mental health symptoms. 

Service contact

ROSIE Findings 4 reports an increase in participants’ contact with GPs, employment/ education services and housing/homeless services.  

The authors state that the findings presented in this paper demonstrate that retention in methadone treatment is high, and continued participation in a methadone programme substantially reduces opiate use, injecting drug use and involvement in crime.  The outcomes for ROSIE participants in the methadone modality compare favourably with international outcome studies.  Although rates of improvement in physical and mental health were disappointing, it is hoped that results from the ROSIE three-year follow-up will provide evidence of a positive association between long-term treatment and improvements in physical and mental health.    

1. Cox  G, Comiskey C and Kelly P (2007) ROSIE Findings 4: summary of 1-year outcomes: methadone modality. Dublin: National Advisory Committee on Drugs. Available at https://www.drugsandalcohol.ie/11517/