Effects of urine testing frequency on outcome in a methadone take-home contingency program

We examined the effects of urine testing frequency on treatment outcome in a contingent methadone take-home program. Study patients who submitted <80% opiate and/or cocaine positive urines during a 5-week baseline received 60 mg methadone throughout the study, submitted urine samples on Monday, Wednesday, and Friday, and were randomized into one of three take-home incentive conditions. Study patients could receive three take-home doses per week if one urine sample randomly selected each week (Weekly; n = 16) or each month (Monthly; n = 18) was negative for opiates and cocaine. Take-homes for Random Drawing control patients (n = 19) were determined weekly independent of urine test results. Subjects in the Weekly group showed an immediate increase from baseline in percentage of drug-free urines; those in the Monthly group showed a gradual increase over the first 3 months; and those in Random Drawings showed a decline in percentage of drug-free urines over time. The percentage of patients with sustained (8 or more weeks) opiate and cocaine abstinence was 56.6, 38.9 and 10.5% for Weekly, Monthly and Random Drawing groups, respectively (P < 0.002). These results confirm that methadone take-homes contingent on drug-free urines prevent a decline in treatment performance over time and suggest that abstinence can be sustained with urine testing conducted as infrequently as once a month.