Quality of Research
Review Date: October 2008
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Yancovitz, S. R., Des Jarlais, D. C., Peyser, N. P., Drew, E., Friedman, P., Trigg, H. L., & Robinson, J. W. (1991). A randomized trial of an interim methadone maintenance clinic. American Journal of Public Health, 81(9), 1185-1191.  Study 2Schwartz, R. P., Highfield, D. A., Jaffe, J. H., Brady, J. V., Butler, C. B., Rouse, C. O., et al. (2006). A randomized controlled trial of interim methadone maintenance. Archives of General Psychiatry, 63(1), 102-109.
Schwartz, R. P., Jaffe, J. H., Highfield, D. A., Callaman, J. M., & O'Grady, K. E. (2007). A randomized controlled trial of interim methadone maintenance: 10-month follow-up. Drug and Alcohol Dependence, 86(1), 30-36.
Supplementary Materials Baltimore Substance Abuse System. (2006). Interim methadone treatment to reduce waiting list. Final report for Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment Grant No. 1H79TI16097-01. Baltimore, MD: Author.
Friedman, P., Des Jarlais, D. C., Peyser, N. P., Nichols, S. E., Drew, E., & Newman, R. G. (1994). Retention of patients who entered methadone maintenance via an interim methadone clinic. Journal of Psychoactive Drugs, 26(2), 217-221.
Highfield, D. A., Schwartz, R. P., Jaffe, J. H., & O'Grady, K. E. (2007). Intravenous and intranasal heroin-dependent treatment-seekers: Characteristics and treatment outcome. Addiction, 102(11), 1816-1823.
Overview of Interim Methadone Treatment quality assurance procedures. (2008).
Outcomes
| Outcome 1: Heroin use |
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Description of Measures
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Heroin use was measured by the following:
- Toxicological analysis of urine samples collected biweekly under observation by program staff (thin layer chromatography with confirmation by gas chromatography/mass spectrometry performed by an independent laboratory)
- Toxicological analysis of urine samples collected at 120-day and 10-month follow-ups (enzyme multiplied immunoassay test [EMIT] by an independent laboratory)
- Self-report responses to the Addiction Severity Index (ASI), a measure of problem severity that provides composite scores for seven domains: medical, legal, employment, drug, alcohol, family, and psychological functioning; composite scores of 0 to 1 are generated for each domain, with higher scores reflecting greater problem severity
- Oral swabs collected by a research assistant at 6 and 7 weeks from study entry (for participants still enrolled in the interim treatment)
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Key Findings
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In one study, IM participants had a significant reduction in heroin use at 30 days from study enrollment compared with a control group who received biweekly follow-up interviews and free condoms and provided urine samples (p < .001).
In another study, IM participants reported significantly fewer days of heroin use at 120-day and 10-month follow-ups compared with wait-list controls (p < .001).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.7
(0.0-4.0 scale)
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| Outcome 2: Entry into a comprehensive methadone treatment program |
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Description of Measures
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The Interim Treatment Study Wait-List Experience Questionnaire, a self-report instrument, was used to assess treatment enrollment status at the follow-up interview. Examples of items are "Right now, are you getting any outpatient treatment?" (yes/no) and "How long have you been receiving the treatment [outpatient drug-free, outpatient detox, methadone maintenance, etc.]?"
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Key Findings
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A significantly greater percentage of participants assigned to IM (76%) reported entering a comprehensive methadone treatment program compared with wait-list controls (21%) during the 120-day evaluation period (p < .001). At 10-month follow-up, 65% of IM participants reported being enrolled in a comprehensive methadone treatment program, compared with 28% of wait-list controls (p < .001).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 3: Criminal behaviors |
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Description of Measures
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Criminal behaviors were assessed using the ASI, a self-report measure of problem severity that provides composite scores for seven domains: medical, legal, employment, drug, alcohol, family, and psychological functioning. The legal subscales were used for this outcome. Examples of items are amount of money spent on drugs in the past 30 days, amount of illegal income in the past 30 days, and days of illegal activity in the past 30 days. Responses ranged from 0 to 1, with higher scores reflecting greater problem severity.
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Key Findings
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At 120-day follow-up, IM participants reported spending less money on drugs (p < .001) and receiving less illegal income than wait-list controls (p < .02). Sustained benefits were seen at 10-month follow-up, when IM participants reported spending less money on drugs (p < .001), obtaining less money from illegal activity (p < .01), and doing illegal activities on fewer days (p < .001).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.7
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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79% Male
21% Female
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55% Hispanic or Latino
35% Black or African American
10% White
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Study 2
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26-55 (Adult)
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60% Male
40% Female
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93% Black or African American
6% White
1% Hispanic or Latino
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Heroin use
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3.9
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3.8
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4.0
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3.0
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4.0
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3.8
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3.7
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2: Entry into a comprehensive methadone treatment program
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2.0
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2.0
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4.0
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3.5
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4.0
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4.0
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3.3
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3: Criminal behaviors
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3.5
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3.0
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4.0
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3.5
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4.0
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4.0
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3.7
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Study Strengths The ASI, urine test, and oral swab measures all have good psychometric properties. Care was taken to deliver the intervention with fidelity, and the fidelity appears to be good. The investigators conducted an excellent analysis of possible confounding variables, and the use of randomization in both studies minimizes concerns about confounds. Both studies employed excellent analytic strategies that were appropriate for the study designs.
Study Weaknesses The Interim Treatment Study Wait-List Experience Questionnaire used in one study has face validity, but complete information on reliability and validity was not provided. Although the investigators addressed attrition and missing data, they did not attempt to model missing data.
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Readiness for Dissemination
Review Date: October 2008
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Overview of Interim Methadone Treatment quality assurance procedures. (2008).
Schwartz, R. P., & Jaffe, J. H. (2008). Interim Methadone Treatment implementation manual. Baltimore, MD: Friends Research Institute.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
|
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2.5
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1.3
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2.5
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2.1
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Dissemination Strengths The manual provides a succinct overview of the intervention and basic steps for implementation. The developer is available to answer implementers' questions via e-mail and telephone. Strategies are provided to ensure a smooth client transition from this interim program to a more comprehensive methadone program. Guidance for monitoring intervention fidelity and outcomes is provided.
Dissemination Weaknesses The program lacks a detailed, step-by-step implementation guide. Although implementers would need little training on methadone maintenance procedures, no guidance or training is offered on how to integrate this add-on interim program into existing organizational structures or how to implement quality assurance procedures. Information on suggested quality assurance procedures is limited.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Intervention manual
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Contact the developer
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Yes
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Phone or email consultation
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Free
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No
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On-site consultation
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Contact the developer
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No
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* Schwartz, R. P., Highfield, D. A., Jaffe, J. H., Brady, J. V., Butler, C. B., Rouse, C. O., et al. (2006). A randomized controlled trial of interim methadone maintenance. Archives of General Psychiatry, 63(1), 102-109.
* Schwartz, R. P., Jaffe, J. H., Highfield, D. A., Callaman, J. M., & O'Grady, K. E. (2007). A randomized controlled trial of interim methadone maintenance: 10-month follow-up. Drug and Alcohol Dependence, 86(1), 30-36.
* Yancovitz, S. R., Des Jarlais, D. C., Peyser, N. P., Drew, E., Friedman, P., Trigg, H. L., & Robinson, J. W. (1991). A randomized trial of an interim methadone maintenance clinic. American Journal of Public Health, 81(9), 1185-1191.
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