Methadone treatment may improve completion of tuberculosis therapy in injection drug abusers

Researchers from the State University of New York Upstate Medical University in Syracuse and the University of California, San Francisco, have found evidence that methadone treatment programs are effective platforms for providing tuberculosis (TB) preventive therapy to substance abusers. In the study, methadone treatment combined with directly observed TB preventive therapy improved adherence to and completion of TB preventive therapy by injection drug abusers.

Previous research has shown that under normal treatment conditions, substance abusers are more likely to miss doses of the TB medication isoniazid (INH) and that direct observation of preventive treatment is less effective in substance abusers than in other TB-positive individuals.

In the study conducted by Dr. Steven L. Batki at San Francisco General Hospital, 111 opioid-dependent patients with latent TB infection were randomly assigned to receive one of three treatments:

• standard methadone treatment¡Xsubstance abuse counseling and directly observed daily INH;
• minimal methadone treatment¡Xdirectly observed INH but with no counseling; and
• routine care-referral to TB clinic for monthly visits for 30-day supplies of INH without direct observation of medication ingestion or methadone treatment.

More than 77 percent of patients receiving minimal methadone treatment and over 59 percent of those receiving standard methadone treatment completed their INH therapy, whereas less than 14 percent of those receiving routine care completed INH therapy. On average, patients receiving both forms of methadone treatment stayed in INH therapy more than five months, while those receiving routine TB treatment stayed in treatment less than two months.

WHAT IT MEANS: The findings from this study indicate that methadone treatment offers public health benefits when it is used to deliver preventive medical services to substance abusers.

Dr. Batki, the lead investigator for the study, reported the findings in the May 2002 issue of Drug and Alcohol Dependence. Dr. Batki is now at SUNY Upstate Medical University.