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Best Practices - Methadone Maintenance Treatment

8. Research and Evaluation

Research and evaluation of methadone maintenance treatment - and particularly research and evaluation in the Canadian context - is essential to:

• increase the understanding, acceptance of and level of support for methadone maintenance treatment in Canada;
• refine program delivery on an ongoing basis;
• identify the most effective ways to address the needs of diverse client/patient groups;
• improve treatment outcomes; and
• reduce the harms associated with opioid-dependence.

8.1 Research Gaps

More research on methadone maintenance treatment is needed in many different areas. For example, some treatment goals have not received as much research attention as others including the role of MMT in the:

• reduction of the transmission of HIV, HCV and other blood-borne pathogens;
• achievement of improvements in clients'/patients' quality of life and social productivity;
• improvements in community public health and safety;
• outcomes for specific groups of clients/patients including, among others, women and ethnocultural groups; and how best to meet these needs;
• treatment of adolescents/youth;
• effectiveness of low threshold interventions in Canadian context;
• program acceptability (to clients/patients and to society);
• alternative medications/treatments available in other countries;
• pain management;
• human resources; and
• screening/assessment and outcome measurement tools (particularly tools designed to make these tasks feasible for practitioners in smaller communities).

There is also a need for more research on the cost-benefits and cost-effectiveness of methadone maintenance treatment.

Insights from the field

• All research requires informed consent of clients/patients and an ethical review process.
• There should be significant client/patient involvement in determining research priorities and expenditures in the MMT field, as well as in conducting and participating in specific research studies.
• Need to develop protocols for research and information collection in the field of MMT. Protocols should identify what is measurable, and clarify what information should be collected, at what level, and how.

8.2 Need for Evaluation

Evaluation of MMT programs is an extremely important tool for determining the extent to which programs meet their objectives and the needs of clients/patients; improving program delivery; and comparing the effectiveness of different types of treatment delivery models.

Client/patient involvement, through the use of inclusive, participatory research techniques should be considered.

A systematic approach to evaluation - and to ensuring that results are published and disseminated - requires the commitment of those delivering treatment, the involvement of clients/patients, and the support of policy makers.