Treatment of Heroin and Cocaine With Methadone Maintenance and Contingency Management
Status:
Completed
Trial end date:
2013-08-09
Target enrollment:
Participant gender:
Summary
Background:
- The treatment of addiction often hinges on preventing relapse into drug-using behaviors,
which occurs at high rates even after prolonged abstinence. Some methadone patients continue
to abuse cocaine and heroin during treatment, even with extensive psychosocial services. More
research is needed to look at the results from earlier studies of continued drug use during
methadone treatment, focusing on the results of fixed vs. flexible doses of methadone to
reduce the likelihood of continued drug use and the role of monetary vouchers as an incentive
to continue abstinence from illicit substances.
Objectives:
- To determine if the combination of flexible methadone dosing and voucher-based contingency
management can improve rates of abstinence from heroin and cocaine.
Eligibility:
- Individuals between 18 and 65 years of age or older who are dependent on opioids (cocaine
and/or heroin).
Design:
- The study will last 40 weeks. After the initial screening, participants will receive
daily methadone and weekly drug counseling sessions that will continue throughout the
study.
- After 6 weeks of methadone treatment, participants who continue to use heroin and
cocaine will be randomized to one of four groups for 16 weeks of study. Each group will
receive a flexible or fixed dose of methadone, and one of two contingency management
conditions.
- Flexible-dose participants will receive individualized dose increases, based on drug use
and withdrawal. Fixed-dose participants will be set at a specific dose of methadone that
will not be changed.
- The two contingency management conditions will be monetary vouchers given for regular
cocaine-negative urine samples, or vouchers independent of urine cocaine screen results.
- After the study phase, participants will have 10 weeks of standard individual counseling
and stable doses of methadone. Urine samples will continue to be collected, but no
vouchers will be given.
- At the end of the study, participants will have the choice of transferring to a
community clinic or undergoing a 10-week taper from methadone.