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Home > Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.

Mattick, Richard P and Breen, Courtney and Kimber, Jo and Davoli, Marina [The Cochrane Library] . (2009) Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews (3) DOI: 10.1002/14651858.CD002209.pub2

URL: http://mrw.interscience.wiley.com/cochrane/clsysre...

Background
Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed.

Objectives
To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence.

Selection criteria
All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence.

Data collection and analysis
Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta-analysis and double-entered.

Main results
Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56-0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10-2.39).

Authors' conclusions
Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.

 

Item Type
Evidence resource
Publication Type
Review
Drug Type
Opioid
Intervention Type
AOD disorder drug therapy
Date
2009
Publisher
John Wiley & Sons, Ltd
Number
3
Notes
Access to the Cochrane Library is free to all Republic of Ireland citizens. Cite this record as: Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD002209. DOI: 10.1002/14651858.CD002209.pub2.
EndNote
Accession Number
HRB (Electronic Only)

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