By Barbara Goodheart, ELS
A key goal in addiction treatment is to reduce the criminal activity associated with substance use disorders. Several studies have shown that a reduction does occur with methadone treatment, but less has been reported about buprenorphine treatment.
The authors of the current study compared criminal charges in patients two years before and two years after their enrollment in either methadone or office-based buprenorphine treatment. Therapy included individual and group counseling, cognitive-behavioral motivational intervention, and contingency contracting. The intensity and frequency of counseling were increased for patients with poor attendance records or drug-positive urine tests.
At study’s end, the methadone group showed a statistically significant decline in proportion of subjects with any charges, especially the proportion with drug charges. A significant drop also occurred in the average number of criminal cases, and in the number of drug cases. The buprenorphine group did not show significant changes in any of these measures. Substance Use & Misuse published the study online April 20.
Enrollees in methadone (252) or buprenorphine (252) treatment, 2003-2007
1.) To compare criminal charges before and after enrollment; 2.) to examine risk factors for criminal charges in the two years after enrollment
Reviewed demographic data from medical records; collected data on criminal charges from a state-maintained data base; used multivariable analysis to assess risk factors
1.) Methadone patients (but not buprenorphine patients) showed a significant decline in the four preassigned measures; buprenorphine patients showed no significant changes in any measure; 2.) the strongest predictor of criminal charges two years after enrollment was prior charges
Buprenorphine treatment did not seem to have the same beneficial effect as methadone treatment on criminal charges two years after enrollment
Several factors could have contributed to the drop:
- Methadone patients are under more intensive treatment and closer observation than buprenorphine patients
- Methadone—a full agonist—may be more effective than buprenorphine at suppressing craving
- Buprenorphine patients have a better opportunity to sell their medication
- Some buprenorphine patients may have been charged with possession only because they were carrying their prescribed medication
To conclude that making office-based buprenorphine treatment more like methadone programs could be a mistake, the authors point out; it might discourage primary care physicians and alienate some patients. They suggest instead “to continue offering a spectrum of treatment options and to focus instead on matching patients to the optimal treatment, which may vary over the course of opioid-use disorder.”
Further research could clarify if findings from this study hold in other settings. If they do, the authors see a need for finding interventions to reduce criminal activity among buprenorphine patients, and perhaps for using criminal activity as a variable when matching patients to the best treatment.
Rastegar DA, Kawasaki SS, King VL, Harris EE, Brooner RK. Criminal charges prior to and after enrollment in opioid agonist treatment: A comparison of methadone maintenance and office-based buprenorphine [Epub ahead of print April 20, 2016]. doi: 10.3109/10826084.2016.1155608. PMID: 27097276. http://dx.doi.org/10.3109/10826084.2016.1155608