Retention rate and illicit opioid use during methadone maintenance interventions: a meta-analysis

Drug Alcohol Depend. 2002 Feb 1;65(3):283-90. doi: 10.1016/s0376-8716(01)00171-5.


The efficacy of methadone maintenance in opioid addiction was assessed in terms of programme retention rate and reduction of illicit opioid use by means of a meta-analysis of randomised, controlled and double blind clinical trials. The results were compared with interventions using buprenorphine and levo-acetylmethadol (LAAM). Trials were identified from the PubMed database from 1966 to December 1999 using the major medical subject headings 'methadone' and 'randomised controlled trial'. Data for a total of 1944 opioid-dependent patients from 13 studies were analysed. Sixty-four percent of patients received methadone, administered either as fixed or adjusted doses. Thus, 890 patients received > or = 50 mg/day (high dose group) and 392 were given < 50 mg/day (low dose group). Of 662 controls, 131 received placebo, 350 buprenorphine (265 at doses > or = 8 mg/day and 85 at doses < 8 mg/day) and 181 LAAM. High doses of methadone were more effective than low doses in the reduction of illicit opioid use (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.26--2.36). High doses of methadone were significantly more effective than low doses of buprenorphine (< 8 mg/day) for retention rates and illicit opioid use, but similar to high doses of buprenorphine (> or = 8 mg/day) for both parameters. Patients treated with LAAM had more risk of failure of retention than those receiving high doses of methadone (OR 1.92, 95% CI 1.32--2.78). It is proposed that in agonist-maintenance programmes, oral methadone at doses of 50 mg/day or higher is the drug of choice for opioid dependence.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Buprenorphine / therapeutic use
  • Humans
  • Methadone / therapeutic use*
  • Methadyl Acetate / therapeutic use
  • Narcotics / therapeutic use*
  • Opioid-Related Disorders / rehabilitation*
  • Patient Dropouts / statistics & numerical data*
  • Randomized Controlled Trials as Topic
  • Substance Abuse Detection
  • Treatment Outcome


  • Narcotics
  • Buprenorphine
  • Methadyl Acetate
  • Methadone