The Substitution
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Maintenenace / Substitution
Maintenance in opioid addiciton means an opioid used as a substitute, administered over a prolonged period of time (can be indefinite), as treatment for someone who is addicted to opioids (such as heroin), where detoxification has been unsuccessful. |
Currently registered medications are:
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Cost Effectiveness
A study in the year 1992 (1) documented that treatment costs of 150.000 patients amounted to 209 Million US $ while the advantages during the first years after the treatment were 1.5 Billion US $. It can be deducted from this study that for every 1 Dollar spent for substitution programs, 7 Dollars of future costs can be avoided. This cost reduction is mainly based on the reduction of criminal activities (drug-related crime) up to 2/3, as well as the reduction of hospitalization of up to 1/3. [1] The benefit achieved by the reduction of criminal activities stands in direct correlation with the time of participation in the substitution program. A study by Ball and Ross [2] deducted that the average time of participation in the substitution program was 4 ½ years. If patients terminated treatment within one year, they returned to their criminal behavior to support their addiction. The “National Association of State Alcohol and Drug Abuse Directors” combined the studies of several US states [3] and came to the conclusion that the employment rate of patients increased in all states conducting such studies with the prolonged participation of the patients in substitution programs. Thus, the employment rate in the state of Montana increased from 21 % at the begin of the study to 56% after participation of the patients in a substitution program for over 24 months. During one further study by Gothin and Anglin [4] compared the social costs of a city that had closed its substitution program to a city with an active substitution program. The main criteria were: treatment, costs of penal system, legal expenses, probation costs, fraud, robbery and public welfare. According to the results of this study the costs for male citizens were 17% higher per person in the city that had closed its substitution program. In 1989 R.L. Hubbard [5] analyzed 41 substitution programs including 11.000 patients who had started substitution between 1979 and 1981. The participants were interviewed after 3 months, 1 year, 2 years, 3 years, and 5 years of treatment. According to the self-evaluation of those participants, the abuse of opioids as well as non-opioids diminished strongly and several participants succeeded in regaining complete abstinence. Based on several interviews it could be deducted that crime-related costs decreased substantially. |
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[1] Programs, California Department of Alcohol and Drug. California Drug and Alcohol Treatment Assessment (CALDATA). Kalifornien : s.n., 1991-1993.
[2] The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. Ball, J.C, Ross, A. New York : Springer-Verlag, 1991.
[3] Alcohol and Other Drug Treatment Effectiveness: A Review of State Outcome Studies. Directors, National Association of State Alcohol and Drug Abuse. USA : s.n.
[4] Shutting off methadone: Costs and benefits. McGlothlin, William H. und Anglin, Douglas. s.l. : Archives of General Psychiatry. Vol 38(8) 885-892, Aug 1981.
[5] Drug Abuse Treatment: a National Study of Effectiveness. Hubbard, R.L., Marsden, M.E., Rachal, J.V. Chapel Hill : University of North Carolina Press, 1989.
[2] The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. Ball, J.C, Ross, A. New York : Springer-Verlag, 1991.
[3] Alcohol and Other Drug Treatment Effectiveness: A Review of State Outcome Studies. Directors, National Association of State Alcohol and Drug Abuse. USA : s.n.
[4] Shutting off methadone: Costs and benefits. McGlothlin, William H. und Anglin, Douglas. s.l. : Archives of General Psychiatry. Vol 38(8) 885-892, Aug 1981.
[5] Drug Abuse Treatment: a National Study of Effectiveness. Hubbard, R.L., Marsden, M.E., Rachal, J.V. Chapel Hill : University of North Carolina Press, 1989.
