Linkage to methadone treatment from acute opiate detoxification treatment


  • Nickolas D. Zaller, PhD
  • Portia Thurmond, MPH
  • Jon Brett, PhD
  • James C. Carleton, MS
  • Josiah D. Rich, MD, MPH



methadone maintenance treatment, injection drug users, detox, HIV prevention


Methadone maintenance treatment (MMT) is a safe pharmacological treatment strategy for addiction to heroin and other opiates; however, linking individuals to MMT is often challenging. We present results from a pilot project (Project VISTA) funded by the Center for Substance Abuse Treatment that helps heroin-dependent injection drug users (IDUs) transition from acute heroin detoxification to MMT. Participants are referred to Project VISTA by the state detoxification center, and Project VISTA facilitates entry into an MMT program, providing full financial support for up to 24 weeks. In addition, Project VISTA provides case management and referral to ancillary services such as housing, other medical care, and mental health treatment. From May 2005 to May 2006, 60 individuals were enrolled in Project VISTA. A total of 41 participants (69.5 percent) remained in treatment for at least 24 weeks, with a mean number of weeks in treatment of 31. A Kaplan-Meier analysis was performed on all participants, and the incidence of individuals being discharged from treatment was 2 percent per week. Project VISTA, in cooperation with the state detoxification center and a Providence-based MMT program, has created a model that provides continuity of treatment services to high-risk, HIV-negative IDUs. Our model demonstrates that through facilitating the transition from an opiate detoxification program into an MMT program, individuals with chronic heroin addiction can successfully access and engage in treatment.

Author Biographies

Nickolas D. Zaller, PhD

Brown University Medical School; The Miriam Hospital Immunology Center, Providence, Rhode Island.

Portia Thurmond, MPH

Brown University Medical School; The Miriam Hospital Immunology Center, Providence, Rhode Island.

Jon Brett, PhD

Residential Alcohol and Drug Detox, Stanley Street Treatment and Resources, North Kingstown, Rhode Island.

James C. Carleton, MS

CODAC Behavioral Healthcare, Providence, Rhode Island.

Josiah D. Rich, MD, MPH

Brown University Medical School; The Miriam Hospital Immunology Center, Providence, Rhode Island.


Gibson DR, Flynn NM, McCarthy JJ: Effectiveness of metha done treatment in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS. 1999; 13(14): 1807-1818.

Gottheil E, Sterling RC, Weinstein SP: Diminished illicit drug use as a consequence of long-term methadone maintenance. J Addict Dis. 1993; 12(4): 45-57.

Dolan KA, Shearer J, MacDonald M, et al.: A randomized controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Drug Alcohol Depend. 2003; 72(1): 59-65.

Marsch LA: The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: A meta-analysis. Addiction. 1998; 93(4): 515-532.

Langendam MW, van Brussel GH, Coutinho RA, et al.: The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health. 2001; 91(5): 774-780.

Mattick RP, Breen C, Kimber J, et al.: Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2003; (2): CD002209.

Sees K, Delucci K, Masson C, et al.: Methadone maintenance vs. 180-day psychosocially enriched detoxification for treatment of opioid dependence: A randomized controlled trial. JAMA. 2000; 283(10): 1303-1310.

Ball JC, Ross A: The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag, 1991.

Ball JC, Lange WR, Myers CP, et al.: Reducing the risk of AIDS through methadone maintenance treatment. J Health Soc Behav. 1988; 29(3): 214-226.

Wong K, Lee S, Lim W, et al.: Adherence to methadone is associated with a lower level of HIV-related risk behaviors in drug users. J Subst Abuse Treat. 2003; 24(3): 233-239.

Kwiatkowski CF, Booth RE: Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. J Acquir Immune Defic Syndr. 2001; 26(5): 483-489.

Greenfield L, Bigelow GE, Brooner RK: Validity of intravenous drug abusers’ self-reported changes in HIV high-risk drug use behaviors. Drug Alcohol Depend. 1995; 39(2): 91-98.

Condelli WS, Dunteman GH: Exposure to methadone programs and heroin use. Am J Drug Alcohol Abuse. 1993; 19(1): 56-78.

McLellan AT, Arndt IO, Metzger DS, et al.: The effects of psychosocial services in substance abuse treatment. JAMA. 1993; 269(15): 1953-1959.

Caplehorn JR, Ross MW: Methadone maintenance and the likelihood of risky needle-sharing. Int J Addict. 1995; 30(6): 685-698.

Longshore D, Hsieh S, Danila B, et al.: Methadone maintenance and needle/syringe sharing. Int J Addict. 1993; 28(10): 983-996.

Lollis CM, Strothers HS, Chitwood DD, et al.: Sex, drugs, and HIV: Does methadone maintenance reduce drug use and risky sexual behavior? J Behav Med. 2000; 23(6): 545-557.

Bouhnik AD, Carrieri MP, Rey D, et al.: Drug injection cessation among HIV-infected injecting drug users. Addict Behav. 2004; 29(6): 1189-1197.

Ward J, Mattick R, Hall W: Key Issues in Methadone Maintenance Treatment. New South Wales, Australia: New South Wales University Press, 1992.

Friedman P, D’Aunno TA, Jin L, et al.: Medical and psychosocial services in drug abuse treatment: Do stronger linkages promote client utilization? Health Serv Res. 2000; 35(2): 443-465.

NIDA: Principles of Drug Addiction Treatment: A Research Based Guide. National Institute on Drug Abuse Web site. Available at Accessed August 22, 2006.

National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction: Effective medical treatment of opiate addiction. JAMA. 1998; 280(22): 1936-1943.

O’Connor PG: Methods of detoxification and their role in treating patients with opioid dependence. JAMA. 2005; 294(8): 961-963.

McLellan AT, Weinstein RL, Shen Q, et al.: Improving continuity of care in a public addiction treatment system with clinical case management. Am J Addict. 2005; 14(5): 426-440.

Simpson DD, Joe GW, Broome KL, et al.: Program diversity and treatment retention rates in the drug abuse outcomes study (DATOS). Psychol Addict Behav. 1997; 11(4): 279-293.

Hunt DE, Lipton DS, Goldsmith DS, et al.: “It takes your heart”: The image of methadone maintenance in the addict world and its effects on recruitment into treatment. Int J Addict. 1985; 20(11-12): 1751-1771.

Rosenblum A, Magura S, Joseph H: Ambivalence toward methadone treatment among intravenous drug users. J Psychoactive Drugs. 1991; 23(1): 21-27.

Stancliff S, Myers JE, Steiner S, et al.: Beliefs about methadone in an inner-city methadone clinic. J Urban Health. 2002; 79(4): 571-578.

Strike CJ, Gnam C, Urbanoski K, et al.: Factors predicting 2-year retention in methadone maintenance treatment for opioid dependence. Addict Behav. 2005; 30(5): 1025-1028.

Strain EC: Assessment and treatment of comorbid psychiatric disorders in opioid-dependent patients. Clin J Pain. 2002; 18(4 Suppl): S14-S17.

Krausz M, Degkwitz P, Kuhne A, et al.: Comorbidity of opiate dependence and mental illness. Addict Behav. 1998; 23(6): 767-783.

Stein M, Friedman P: Need for medical and psychosocial services among injection drug users: A comparative study of needle exchange and methadone maintenance. Am J Addict. 2002; 11(4): 262-270.

Deck D, Carlson MJ: Retention in publicly funded methadone maintenance treatment in two Western States. J Behav Health Serv Res. 2005; 32(1): 43-60.




How to Cite

Zaller, PhD, N. D., P. Thurmond, MPH, J. Brett, PhD, J. C. Carleton, MS, and J. D. Rich, MD, MPH. “Linkage to Methadone Treatment from Acute Opiate Detoxification Treatment”. Journal of Opioid Management, vol. 2, no. 6, Nov. 2006, pp. 341-6, doi:10.5055/jom.2006.0050.