Methadone and quality of life
Sir Jeff Ward and colleagues (Jan 16, p 221)1 describe heroin dependence as a chronic disease for which patients need to be under treatment for many years. They review the efficacy of one of the most extensively used therapies, methadone maintenance treatment (MMT), in terms of the reduction of heroin use, criminal activity, retention rates in treatment, reduction in mortality among heroin users, and protection against HIV infection.
Although these indicators are relevant and useful when evaluating MMT in heroin users, the comparison of the outcomes of treatment with those of other conditions is limited.
The development of health-related quality-of-life measures has allowed the comparison of the impact of disease and the outcomes of treatment for different conditions.2 Several studies have shown that heroin users at entry to MMT have substantial physical and psychological impairment, which is greater than that of patients with chronic obstructive pulmonary disease or coronary artery disease.3, 4
It has also been shown that health-related quality of life improves substantially in the patients in MMT programmes.4 This improvement is greatest at the end of the first month in treatment, and may be seen before other indicators are modified (such as heroin use or criminal activities).
In our study,4 the overall score of the Nottingham health profile, a generic perceived health questionnaire, diminished (improved) over the 3 years of observation in 47 patients on MMT: from 53% (SD 26%) at baseline, to 33% (27%) in the first month, 24% (20%) at 12 months, 22% (21%) at 24 months, and 21% (22%) at 36 months (p=0·0001; figure). This trend was recorded in all six specific dimension scores of the questionnaire.
Because heroin addiction is chronic and relapsing, one of the goals of MMT is to improve and maintain patients’ health in a wide sense. Thus, health-related quality-of-life measures, such as the Nottingham health profile,5 are relevant to assess more thoroughly the health impact of this disorder and to evaluate treatment efficacy. In our study with patients in MMT, we found that the improvement of health-related quality of life lasted for 3 years. Thus, patients who are in treatment for at least 3 years will have a continued improvement in quality of life. As such, this improvement reinforces the recommendation of keeping in MMT for long periods.
This study was partly supported by FIS grant 95/0311.
Overall Nottingham health profile scores in 47 patients followed for 3 years on MMT
Score range 0 – 100, lower scores indicating better perceived health (ANOVA, p=0·0001).
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References
1 Ward J, Hall W, Mattick R. Role of maintenance treatment in opioid dependence. Lancet 1999; 353: 221-226.
2 McDowell I, Newell C. Measuring health. New York: Oxford University Press, 1996.
3 Ryan CF, White J. Health status at entry to methadone maintenance treatment using the SF-36 health survey questionnaire. Addiction 1996; 91: 39-45.
4 Torrens M, San L, Marti’nez A, et al. Use of Nottingham Health Profile for measuring health status of patients in methadone maintenance treatment. Addiction 1997; 92: 707-716.
5 Alonso J, Prieto L, Anto’ JM. The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics. Qual Life Res 1994; 3: 385-393.
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Marta Torrens, Antonia Domingo-Salvany, Jordi Alonso, Claudio Castillo, Lui’s San
The Lancet, Volume 353, Issue 9158, Page 1101, 27 March 1999
doi:10.1016/S0140-6736(05)76462-X