Drug and Alcohol Dependence 2006 81;1:55-61
Cycling in and out of treatment; participation in methadone treatment in NSW, 1990-2002. Bell J, Burrell T, Indig D, Gilmour S.
Dear Colleagues,
In New South Wales doctors fill out various coloured forms every time a patient starts, stops or transfers opioid maintenance treatment. The Health Department used to release statistics regularly yet little has appeared in recent years. Here, the hard work of Bell et al. pays off with a useful analysis of some of the details of sample cohorts of all patients starting their first treatment episode during February 1990, 1995 and 2000 (n = 477). February was chosen since it is the first 'normal' month after the summer holiday season.
Retention at 3, 6 and 12 months is tabulated for public [free to the patient] and private [typical cost to patient A$40 (~US$30) per week] systems. There was no significant difference between the sectors and retention rates were 64%, 51%, 38% at 3, 6 and 12 months with 12% of the first two cohorts still remaining in their initial episode at 5 years.
Five years from admission, 45% of original entrants were still registered for maintenance treatment and 75% of these had been continuous or had one break in treatment. 25% had between 3 and 9 treatment episodes.
Overall about two thirds of discharged patients re-entered treatment, the majority within 2 years from discharge. Those more likely to be re-admitted to treatment were young patients as well as those who had a short initial treatment episode (< 3 months). Overall the number discharged after 'successful dose reductions' was 68 (17%) and these patients had been in treatment an average of 2 years at discharge.
The initial cohort from 1990 had an average treatment period of 4.8 years during 2.6 episodes over the 12 year follow-up possible in this study.
Also, 67% dropped out for unspecified reasons. The rest reportedly 'transferred' (8%), were discharged involuntarily (1.5%) or died (1%). Another 69 patients remained in their initial treatment episode (14% of original total).
There were 342 subjects commencing treatment in private clinics while 135 started in public settings (only exceptionally are new entrants started in pharmacies in NSW).
This is a fine demonstration of the natural history of citizens' opiate use as well as their interaction with a mature and flexible medical maintenance service (available in hospitals, pharmacies, private clinics, public clinics and all jails). It is also consistent with Thorley's old review: "over a seven year period, something over a third of dependent subjects will cease opiate use and a very small number will have moved to intermittent use. Approximately 2% will die each year, and after seven years, around 5% will be in prison and 80% will be divided almost equally into a group attending drug clinics and [therefore] in receipt of a legal prescription, and a group not attending clinics and in the community".
Comments by Andrew Byrne ..
Thorley A. Longitudinal Studies of Drug Dependence. In: Drug Problems in Britain: A review of ten years. Eds: Edwards G, Busch C. 1981, Academic Press. p162
Bell J, Burrell T, Indig D, Gilmour S. Cycling in and out of treatment; participation in methadone treatment in NSW, 1990-2002. Drug and Alcohol Dependence 2006 81;1:55-61
