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Background  Over-standard methadone doses are generally needed in the treatment of heroin use disorder (HUD) patients that display concomitant high-severity psychopathological symptomatology. A flexible dosing regimen may lead to higher retention rates in dual disorder (DD), as we demonstrated in bipolar 1 HUD patients, leading to outcomes that are as satisfactory as those of HUD patients without high-severity psychopathological symptomatology.    Objective  This study aimed to compare the long-term outcomes of treatment-resistant chronic psychosis HUD patients (PSY-HUD) with those of peers without dual disorder (HUD).    Methods  85 HUD patients who also met the criteria for treatment resistance—25 of them affected by chronic psychosis and 60 without DD—were monitored prospectively for up to 8 years while continuing to receive enhanced methadone maintenance treatment.    Results  The rates of endurance in the treatment of PSY-HUD patients were 36%, compared with 34% for HUD patients ( p  = 0.872). After 3 years of treatment, these rates tended to become progressively more stable. PSY-HUD patients showed better outcome results than HUD patients regarding CGI severity ( p  &lt; 0.001) and DSM-IV-GAF ( p  &lt; 0.001). No differences were found regarding good toxicological outcomes or the methadone dosages used to achieve stabilization. The time required to stabilize PSY-HUD patients was shorter ( p  = 0.034).    Conclusions  An enhanced methadone maintenance treatment seems to be equally effective in patients with PSY-HUD and those with HUD.

The long-term outcome of patients with heroin use disorder/dual disorder (chronic psychosis) after admission to enhanced methadone maintenance