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more likely that a commitment to honesty will be seen as part of the
recovery process, and that patients will disengage from social
networks of users. This is one of a number of reasons that criminal
behavior tends to continue to decrease after the initial reductions.

In recent years, the gains possible for methadone patients have been
undercut by the spread of cocaine into most urban environments and
many rural ones. A criminal history that is not related to drug use and
cocaine use are two factors that reduce treatment effectiveness among
methadone patients. Cocaine use has remained a challenging problem
for most programs.

Improvement in Health Status

Methadone patients have a 4-8 fold reduction in death rate compared
to those untreated. Reductions in various types of illness also occurs,
because many of those in treatment are able to extricate themselves
from the health hazards of a drug using life style, and access to
physicians in the clinics provides some opportunity for early referral
for emergent problems. Programs that can offer comprehensive
physical and mental health services show significantly better outcomes
for their patients. Although it would seem that programs that were
part of large-scale medical systems would be better able to provide
comprehensive care, barriers within such systems often deter such
efforts. Clinics must have the resources to advocate vigorously for
good care for their patients, and to closely coordinate that care once it
is available.

Ironically, the advent of the HIV epidemic in 1978 made methadone
treatment visible in a positive way and resulted in a re-examination of
issues previously buried under the stigma. The new emphasis on a
public health perspective brought a re-examination of attitudes and
practices. Studies of HIV in injection drug users indicate that the
longer a group of patients was in MMT, the lower the seropositivity
for the HIV virus. Although some patients in MMT do engage in risky
behavior and acquire the virus, HIV conversion is lower in MMT
patients than those outside methadone treatment. Studies showed that
patients who were not in treatment were injecting drugs, sharing