Effects of urine testing frequency on outcome in a methadone take-home contingency program

FRANÇAIS :
L'étude porte sur 231 patients en traitement par la méthadone, à la dose de 60mg/j, soumis aux prélèvements urinaires trois fois par semaine, les lundi, mercredi et vendredi. On compare trois protocoles : ceux à qui on donne la méthadone à emporter trois fois par semaine, à condition qu'un test urinaire par semaine soit négatif (Groupe 1), ceux à qui on la donne si un test par mois est négatif (Groupe 2) et ceux à qui on la donne sans tenir compte des tests urinaires (Groupe 3). Dans le groupe 1, le nombre des tests négatifs aux opiacés augmente, dans le groupe 2, on observe également une augmentation progressive du nombre de tests négatifs sur trois mois, alors que dans le groupe 3, les tests négatifs diminuent. L'obligation de non consommation d'opiacés que représente les prélèvements urinaires semble renforcer l'efficacité du traitement.
ENGLISH:
We examined the effects of urine testing frequency on treatment outcome in a contingent methadone take-home program. Study patients who submitted < 80% opiate and/or cocaine positive urines during a 5-week baseline received 60 mg methadone throughout the study, submitted urine samples on Monday, Wednesday, and Friday, and were randomized into one of three take-home incentive conditions. Study patients could receive three take-home doses per week if one urine sample randomly selected each week (Weekly; n = 16) or each month (Monthly; n = 18) was negative for opiates and cocaine. Take-homes for Random Drawing control patients (n = 19) were determined weekly independent of urine test results. Subjects in the Weekly group showed an immediate increase from baseline in percentage of drug-free urines; those in the Monthly group showed a gradual increase over the first 3 months; and those in Random Drawings showed a decline in percentage of drug-free urines over time. The percentage of patients with sustained (8 or more weeks) opiate and cocaine abstinence was 56.6, 38.9 and 10.5% for Weekly, Monthly and Random Drawing groups, respectively (P < 0.002). These results confirm that methadone take-homes contingent on drug-free urines prevent a decline in treatment performance over time and suggest that abstinence can be sustained with urine testing conducted as infrequently as once a month. (Author's abstract.)