Abstinence incentives for methadone-maintained stimulant users: Outcomes for those testing stimulant-positive versus negative at study intake.

Baseline drug use can predict treatment outcome, and methadone maintenance patients with relatively lower levels of on-going drug abuse have generally been over-represented among patients who respond well to abstinence incentive interventions. This study examined data from the National Drug Abuse Treatment Clinical Trials Network MIEDAR protocol (CTN-0007: Motivational Incentives for Enhanced Drug Abuse Recovery: Methadone Clinics) to assess the association between intake urine test result and treatment outcome and to determine whether abstinence incentives were differentially effective in methadone maintained stimulant users testing stimulant negative versus positive at study entry.

Data were from 386 stabilized methadone maintained patients who participated in the CTN multi-site study involving random assignment to usual care with vs. without abstinence incentives; 24% tested stimulant negative at study entry and 76% tested positive. Intake urine test result was strongly associated with overall percent of during-treatment stimulant negative urines submitted (82% versus 34% negative samples). However, abstinence incentives had a significant effect on percent of negative samples submitted during the study both for those testing negative at study entry and for those testing stimulant positive at study entry. These findings suggest that abstinence incentives can be beneficial regardless of baseline drug use severity and can therefore be offered to all methadone maintenance patients with on-going stimulant drug use, with reasonable expectation that they will improve overall treatment outcomes for this difficult to treat group of patients.

Related protocols: CTN-0007