In-patient treatment of opiate dependence: medium-term follow-up outcomes

BACKGROUND: The outcome for opiate-dependent patients seeking abstinence is unclear in this era of improved access to methadone maintenance. AIMS: To measure the outcome 2-3 years after in-patient treatment. METHOD: Opiate-dependent patients admitted with a goal of abstinence were followed-up. A structured interview examined drug use and treatment in the preceding month. RESULTS: Five patients had died and 109 (76%) of the remaining 144 were interviewed. Fifty per cent (54 patients) reported recent opiate misuse and 57% (62) were on methadone maintenance. Twenty-three per cent (25 patients) were abstinent (i.e. neither using opiates nor on methadone maintenance). Abstinence was significantly associated with completion of the 6-week in-patienttreatment programme and attendance at out-patient after-care, and negatively associated with a family history of substance misuse. CONCLUSIONS: Abstinence remains an attainable goal. As the principal influence on outcome was treatment adherence, inpatient services should seek to enhance rates of programme completion. After-care should be provided to patients. We caution against use of pre-treatment patient characteristics as criteria for prioritising access to in-patient treatment.