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Differential effects of methadone dose/contingency management combinations on abstinence from heroin and cocaine
Author(s) -
Preston K. L.,
Schmittner J.,
Schroeder J. R.,
Boyd S. J.,
Moolchan E. T.,
Epstein D. H.
Publication year - 2004
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1016/j.clpt.2003.11.079
Subject(s) - methadone , heroin , contingency management , methadone maintenance , abstinence , medicine , anesthesia , pharmacology , intervention (counseling) , drug , psychiatry
Continued illicit drug use remains a significant problem among patients in methadone maintenance. This study examined the interaction between a pharmacological and a behavioral intervention in patients using illicit heroin and cocaine while in methadone maintenance therapy. The behavioral intervention (contingency management) reinforced abstinence from heroin and cocaine. The pharmacological intervention was a 30‐mg methadone dose increase. Methadone‐maintained outpatients (N=XXX) were randomly assigned to 4 groups: dose increase & contingent vouchers (given separately for heroin‐ and cocaine‐negative urine screens); dose increase & noncontingent vouchers (independent of urine screen results); no dose increase & contingent vouchers; no dose increase & noncontingent vouchers. The intervention lasted 12 weeks. Analysis of thrice‐weekly urine screen results showed that an increase in methadone dose (from 70 to 100 mg/d) significantly reduced heroin use, but not cocaine use, while contingent vouchers significantly reduced both heroin and cocaine use. The effects on heroin use were enhanced by combining the contingency and dose increase interventions, an effect not found in a previous study with lower methadone doses (50 and 70 mg/d; Preston et al., Arch Gen Psychiatry 57, 395–404, 2000), nor found for cocaine in this study. Thus, the interaction between methadone and the behavioral treatment was pharmacologically specific and sensitive to dose. Clinical Pharmacology & Therapeutics (2004) 75 , P21–P21; doi: 10.1016/j.clpt.2003.11.079