No controlled studies have compared short-term methadone maintenance (MM) to methadone detoxification (MD), although it is known that open-ended MM is more effective than MD. Gruber et al. took advantage of a randomized controlled trial (RCT) assessing the effect of 6-month MM on adherence to latent tuberculosis therapy to compare 21-day MD to 6-month MM with either minimal or standard counseling.

In this RCT (n=111), outcomes were substance use and depressive symptoms. Doses of methadone were between 60 and 90 mg per day. Minimal counseling involved a single 15-minute session per month with no contingencies (e.g., take-home medication). Standard counseling involved 2 sessions per month (more, if needed, as determined by the counselor) with the opportunity to earn take-home medications. The majority of subjects were male, nonwhite, poor, and not interested in stopping heroin but rather in cutting down on use.

• Compared with 6-week MD, 6-month MM resulted in a greater decrease from baseline in self-reported opiate use, opiate positive urines and days of alcohol use.
• No difference between groups was found for cocaine use or depressive symptoms.
• Results for MM with standard counseling did not differ from those for MM with minimal counseling.

Comments by James Harrison, MHS, CADC
Methadone maintenance is the preferred treatment approach for heroin dependence. In this study, most of the participants were interested in limiting heroin use rather than abstaining from it. Although standard and brief counseling yielded similar outcomes, the use of counseling supported by the best evidence, e.g., use of motivational enhancement therapy, might have improved outcomes over those achieved by the counseling studied. The most significant results of this RCT suggest that cocaine use and depressive symptoms need to be addressed regardless of the treatment modality for opioid dependence.