ABSTRACT
BACKGROUND/OBJECTIVE: This study sought to determine whether case management was positively associated with improved outcomes and treatment compliance in those enrolled in a methadone maintenance treatment (MMT) program. METHODS: An intervention group (n = 396) received case management while the other group (n = 1308) did not. Total N = 1704. RESULTS: Statistically significant reductions were seen in the intervention group, in the proportion of urine samples positive for drugs of abuse (relative risk reduction = -15.4% (95% confidence interval (CI): -17.7, -13.1)), missed daily methadone doses (-1.9% (95% CI: -2.4, -1.4)), and missed physician appointments (-40.1% (95% CI: -43.7, -36.3)). CONCLUSIONS/SCIENTIFIC SIGNIFICANCE: Case management appears to be a very valuable tool in MMT programs.
Subject(s)
Case Management , Heroin Dependence/drug therapy , Methadone/therapeutic use , Opiate Substitution Treatment , Patient Compliance , Humans , Retrospective Studies , Substance Abuse Detection , Treatment OutcomeABSTRACT
OBJECTIVE: We sought to test the assumption that a low urine creatinine level is indicative of the presence of alcohol in the urine of patients prescribed methadone. METHODS: This is a medical record review of 261,055 urine samples from approximately 6,000 patients prescribed methadone during a one-year period and for whom both urine creatinine and ethanol levels were simultaneously measured. We defined a creatinine level of less than 2.26 mmol/L as 'low' used a urine ethanol level of greater than 2.0 mmol/L as the reference standard for alcohol consumption. RESULTS: The sensitivity and specificity of low urine creatinine as a marker for the detection of urine ethanol are 11.9% (95% CI: 11.3, 12.5%) and 96.7% (95% CI: 96.7, 96.7%), respectively. In this patient population with a low (3.6%) prevalence of alcohol in the urine, the results correspond to a positive predictive value of 11.9% (95% CI: 11.3, 12.6%) and a negative predictive value of 96.7% (95% CI: 96.7, 96.7%), respectively. CONCLUSIONS: Low urine creatinine is a poor screening test for detecting alcohol consumption among patients on methadone. However, a normal creatinine level has a 96.7% probability of no alcohol urine present in the urine.
Subject(s)
Creatinine/urine , Ethanol/urine , Methadone/therapeutic use , Opioid-Related Disorders/rehabilitation , Analgesics, Opioid , Biomarkers, Pharmacological/urine , Humans , Medical Records , Ontario , Sensitivity and Specificity , Substance Abuse DetectionABSTRACT
Alcohol use among Methadone Maintenance Treatment (MMT) patients poses a major health risk, exacerbates psychopathology, and increases the risk of death by accidental overdose. Despite these factors, screening for alcohol use remains underutilized in the methadone community. Utilizing a self-report screening measure - the Michigan Alcohol Screening Test (MAST) - and consistent with the literature, we found high rates of alcohol problems among MMT patients. Benefits and limitations of using the MAST to screen for alcohol use patterns are discussed.
