The aging methadone maintenance patient: Treatment adjustment, long-term success, and quality of life

Ranjit Rajaratnam, MD; David Sivesind, PhD; McWelling Todman, PhD; David Roane, MD; Randy Seewald, MD

doi:10.5055/jom.2009.0004

Authors

Ranjit Rajaratnam, MD
David Sivesind, PhD
McWelling Todman, PhD
David Roane, MD
Randy Seewald, MD

DOI:

https://doi.org/10.5055/jom.2009.0004

Keywords:

methadone maintenance, aging

Abstract

Objective: To evaluate the features and modes of adaptation to aging among Methadone Maintenance Treatment (MMT) enrollees.
Setting: Beth Israel Medical Center in New York City.
Participants: A sample of 156 MMT enrollees (103/66 percent males and 53/34 percent females) age 24-68 years. Twenty-nine percent of participants were aged 55 or older.
Design: A cross-sectional, multivariate, correlational design.
Outcome Measures: Participants were administered the MMSE, ASI, BSI, as well as measures of impulsiveness and quality of life (QOL).
Results: Older adults were more likely to have had longer periods of treatment (p < 0.01), less likely to report current heroin use (p < 0.05) and overall drug use (p < 0.05), but were more likely to have a history of comorbid alcohol misuse (p < 0.01). Advanced age was also associated with less impulsiveness, hostility, paranoia, and interpersonal sensitivity (p < 0.01), more chronic medical problems (p < 0.05), greater use of medication for medical problems (p < 0.05), and more liberal take home medicine schedules (p < 0.01). However, no differences were found between older and younger participants with respect to their scores on the Overall Social Support scale (p > 0.05), the Personal Well-Being Index (p > 0.05) and the Satisfaction with Life Scale (p > 0.05), suggesting comparable levels of QOL. Furthermore, the rate of contact for older participants with medical professionals did not differ significantly from that of younger participants (p > 0.05). Only 7.1 percent of older participants reported regular contact with a primary care physician; a rate that is slightly lower than the rate in the overall population.
Conclusions: The findings from the present study highlight at least two underappreciated challenges that clinicians are increasingly likely encounter in their work with the aging MMT population. These challenges are: (1) that despite numerous medical and psychiatric complaints, only a small proportion of MMT patients have regular contact with a primary care physician and the rate of contact does not appear to increase with age and (2) even with age-related declines in psychiatric comorbidity and illicit substance use, the suboptimal level of QOL that is characteristic of the MMT population as a whole does not improve with aging and length of tenure in MMT.

Author Biographies

Ranjit Rajaratnam, MD

Department of Psychiatry, Beth Israel Medical Center, Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, New York.

David Sivesind, PhD

Department of Psychology, New School for Social Research, New York, New York.

McWelling Todman, PhD

Associate Professor for Clinical Practice, Director, Concentration in Mental Health and Substance Abuse (CMHSA), Department of Psychology, New School for Social Research, New York, New York.

David Roane, MD

Associate Chairman for Education, Department of Psychiatry, Beth Israel Medical Center, Associate Professor of Clinical Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, New York.

Randy Seewald, MD

Medical Director, Beth Israel Medical Center, Methadone Maintenance Treatment Program, Assistant Professor, Albert Einstein College of Medicine, New York, New York.

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