Drug and Alcohol Dependence 56 (1999) 61–66 Methadone treatment in Spain, 1994 Anto ` nia Domingo-Salvany a, *, Katerine Pe ´rez a , Marta Torrens b , Marı ´a Jose ´ Bravo c , Josep M. Anto ´ a , Jordi Alonso a a Institut Municipal d’Inestigacio ´ Me `dica (IMIM), Dr. Aiguader 80, 08003 Barcelona, Spain b Hospital del Mar, Barcelona, Spain c Delegacio ´n del Gobierno para el Plan Nacional sobre Drogas, Madrid, Spain Received 28 August 1998; received in revised form 11 November 1998; accepted 28 January 1999 Abstract The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13 402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10 000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement. © 1999 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Health services; HIV; Methadone 1. Introduction In prevention of human immunodeficiency virus (HIV) infection among intravenous drug users, metha- done treatment (MT) is recognized as having a protec- tive effect (Schoenbaum et al., 1989; Novick et al., 1990; Marsch, 1998). During the late 1980s the need to develop methadone maintenance treatment in those countries without these programs was emphasized. Wide variability in the implementation of methadone treatment has been documented (Ball and Ross, 1991; Gossop and Grant, 1991; D’Aunno and Vaughn, 1992), and although some specific treatment features have been shown to be effective, they are not fully accepted/ implemented everywhere. In Spain HIV infection among intravenous drug users is an important public health problem (De La Fuente et al., 1995). MT programmes started in the early 1980s, and their characteristics have changed over time. Initially, MT was used at the individual physi- cian’s discretion, mostly in private practices. In 1985, a law came into force abolishing private methadone ad- ministration, and public methadone treatment centers were created in several Spanish Autonomous Commu- nities (hereafter called Regions). Admission to MT was very restrictive and final inclusion granted by an adhoc Commission. Following legislation passed in January 1990, many existing public drug treatment centers in- cluded MT in their therapeutic offer and new drug treatment centers were created to include MT. To be able to provide MT these centers needed acreditation and had to provide the Region with a monthly list of all patients included in MT and their current status. Such centers were the only settings where MT (including methadone provision) was available in Spain (Farrell et al., 1996) and were run by specialized professionals (psychologists, psychiatrists and physicians). This latest legislation did not provide specific guidelines for prac- tice, but constituted a general frame within which the * Corresponding author. Tel.: +34-93-2211009; fax: +34-93- 2213237. E-mail address: adomingo@imim.es (A. Domingo-Salvany) 0376-8716/99/$ - see front matter © 1999 Elsevier Science Ireland Ltd. All rights reserved. PII:S0376-8716(99)00011-3