Methadone maintenance treatment in Italy needs improvement

Methadone at appropriate doses has been demonstrated to be the most effective means for retaining patients in treatment and suppressing heroin use. The study aims to describe the modalities of day-to-day provision of methadone maintenance treatments in Italian public health centres and to analyze the duration of methadone maintenance treatments by dose and by association with psychosocial treatments. 8,378 subjects were analyzed, 18 years of age or over, enrolled between September 1998 and March 2001 in one of 115 public treatment centres for heroin dependence in Italy. Treatment data were collected for each subject from enrolment to the end of the study period (maximum of 18 months).

Of the total of 29,495 treatments delivered, 21.0% were methadone maintenance, and 34.4% were methadone detoxification. Fifty percent of methadone maintenance treatments offered had a mean dose less than or equal to 40 mg/day, and only 19% had doses higher than or equal to 60 mg/day. Treatments with doses higher than 60 mg/day lasted longer than treatments with lower doses. Differences in treatment length were observed between methadone maintenance treatments associated with a psychosocial treatment and those offered alone, only for doses

The study shows that an increase of methadone doses to adequate levels as indicated by the literature is necessary to ensure proper and effective use of methadone maintenance treatments in public treatment centres for heroin users.