PATIENT BELIEFS ABOUT METHADONE MAINTENANCE:

A study that is 7 years old but still of vital importance describes the results of a survey of patient beliefs about methadone maintenance – which, on average, the 315 respondents had been receiving for seven years in a public clinic in NYC. Among the findings:

. although 79% agreed that “methadone has helped me change my life in a good way,”
the negative beliefs that were expressed were distressing.
. 47% believed methadone “is bad for your health (additional 32% “not sure”)
. 39% believed higher doses “are less healthy than lower doses” (30% unsure)
. 71% (!) believed “methadone gets into your bones” (19% unsure)
. 80% believed “people should try to get off methadone” (11% unsure)

There is no reason to believe that in the intervening years since this study was done much has changed (certainly the public’s perception does not seem to have become more favorable, so there’s presumably no cause for optimism regarding a change among recipients of care). The responses can be interpreted in only one way: the clinic staff have been woefully ineffective at educating their patients about the medication that is fundamental to the care provided. Even more distressing is the possibility that many patients may be mirroring the attitudes and beliefs of staff members.

It is difficult to imagine that treatment will be optimally effective when patients believe the medication they receive is injurious to their health and should be given in doses that may be inadequate. Patients who believe one should aim to discontinue treatment will be likely to do so - notwithstanding the high rate of recidivism and all the concomitant risks (including, very specifically, the risk of death).

Surely patient knowledge about their treatment is a most important parameter of quality care. Is anyone aware of programs that focus on this treatment imperative? Do the accreditation bodies assess the process and outcome of this aspect of care?

Comments welcomed.
Citation: Stancliff S, Myers JE, Steiner S and Drucker. Beliefs about methadone in an inner city methadone clinic. 2002. Bull NY Acad Med. 79(4):571-578.