Page 61 - 1
P. 61
61
Cost-Benefit Studies
Cost-benefit studies repeatedly show that the benefits of methadone
treatment outweigh the costs. The large California CALDATA
(Gerstein, Johnson, Harwood, Suter, & Malloy, 1994) study released
in 1994 indicated that methadone treatment showed the greatest
savings of all existing treatment and recovery modalities studied. The
study found a ratio of 1:10, meaning that $10 was saved for every $1
invested in treatment. Other studies, usually focusing on single
episodes of treatment, report similar findings. A recent study that used
a lifetime simulation model found a benefit-cost ratio of 1:38 (Zarkin,
Dunlap, Hicks, & Mamo, 2005). This model factors in existing data
where possible to create a lifetime model more compatible with the
view of addiction as a chronic disorder characterized by relapse over
time, rather than an acute problem that can be addressed in a single
treatment episode.
Key Outside Reviews
There are three outside scientific reviews that played a significant role
in reducing the stigma and encouraging effective treatment. In 1990,
the Government Accounting Office (Government Accounting Office,
1990) (since renamed Government Accountability Office) conducted a
study of methadone programs and produced a striking finding about
dosing. Although the National Institute on Drug Abuse had
documented that 60 mg methadone was a minimum adequate dose, 21
of the 24 programs studied had average doses below that. Often,
physicians were constrained by “program policy” and could not
prescribe appropriate doses. Subsequent research documented that
increasing the dose of methadone resulted in greatly improved
retention and reductions in drug use. Doses of 80 mg and above
produced the best outcomes, with much higher doses required by some
patients. Unfortunately, it is still not unusual to find patients,
clinicians and program administrators attempting to make a virtue out
of low doses. Patients vary enormously in their level of opiate
tolerance and dependence, and in how well they absorb, metabolize
and eliminate the medication. Doses must be individualized and not
limited by “policy.” If a patient is continuing to use opiates, the first