Drug and Alcohol Dependence 82 (2006) 211–217 Factors predicting retention in treatment: 10-year experience of a methadone maintenance treatment (MMT) clinic in Israel Einat Peles a,∗ , Shaul Schreiber a,b , Miriam Adelson a a Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Elias Sourasky Medical Center, 6 Weizman Street, 64239 Tel-Aviv, Israel b Department of Psychiatry, Tel Aviv Sourasky Medical Center (affiliated to the Sackler Faculty of Medicine Tel-Aviv University), Tel-Aviv, Israel Received 9 July 2005; received in revised form 20 September 2005; accepted 20 September 2005 Abstract The aims were to identify predictors of treatment retention in an Israeli methadone maintenance treatment (MMT) clinic, and to compare the findings to other international settings. We prospectively studied 492 patients admitted since 1993 through 10 years to an Israeli MMT clinic associated with a university-affiliated tertiary care medical center. Analyses (Kaplan Meier and Cox regression) included methadone dose and urinalysis results (for methadone, cocaine, opiates, benzodiazepines, THC, amphetamines) of each patient in the first month and after 1 year in treatment (or during the last month if the stay was >3 months and <1 year) and patients’ characteristics (modified ASI). The 1-year retention rate was 74.4%; 65.8% stopped opiate abuse after 1 year in treatment. On admission, 13.6% of patients had used cocaine: there was a net decrease of 61.6% after 1 year. Factors predicting prolonged retention in MMT treatment (Cox regression) were daily methadone dose of 100mg or greater, negative urine for opiates after 1 year, and being a parent on admission. We conclude that our good outcome results (high rate of retention after 1 year (74.4%), high proportion of opiate abuse cessation (65.8%), and net reduction in cocaine abuse, similar to normal standards in other MMT clinics elsewhere in the world, justify the expansion of the MMT clinic network in Israel in order to make treatment available to all those who need it. A protocol favoring higher methadone dosage as appropriate is recommended. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Methadone maintenance treatment; Kaplan Meier survival analyses; Retention; Predictors 1. Introduction Methadone maintenance treatment (MMT) is the most effec- tive pharmacotherapy for heroin addiction Dole et al., 1966; NIH Consensus Statement, 1997). Good MMT programs include psychosocial as well as medical therapy, the importance and con- tribution of which are well established for therapeutic success (McLellan et al., 1993). In Israel, MMT has been available with various restrictions for opiate-dependent patients since 1973. The Israeli Ministry of Health decreed in 1992 that all MMT clin- ics should be under the jurisdiction of the Ministry, and that only medical doctors associated with these clinics are permitted by law to prescribe methadone. There are 10 MMT clinics in Israel: 8 are located in community settings while the 1 reported here (established on 25 June 1993) is located within a large, munici- ∗ Corresponding author. Tel.: +972 369 732 26; fax: +972 369 738 22. E-mail address: einatp@tasmc.health.gov.il (E. Peles). pal, university-affiliated medical center. It is estimated that there are approximately 20,000 heroin addicts in Israel (Israel Anti- drug Authority, 2004) of whom only about 3000 (approximately 15%) are receiving MMT. In the United States, 170,000 of the estimated 810,000 opioid- dependent individuals (∼21%) are in MMT programs (Office of National Drug Control Policy, 1999). The guidelines for con- ducting MMT programs in Israel were adopted from those used in the US (detailed in Adelson et al., 2000). MMT programs are generally similar worldwide. Neverthe- less, the patients’ characteristics, the levels of drug abuse and the rates of hepatitis C and HIV infection are reported to be higher in the US compared with the Israeli patient population. Therefore, 10 years after its establishment, as was done 4 years after its inauguration (Adelson et al., 2000), outcomes for the present program were examined. Since no accurate data on 1- year retention rates and drug abuse in other Israeli MMT clinics are available (Adelson et al., 2000; Bleich et al., 2002; Weizman et al., 2004), it is assumed that the present clinic is representative 0376-8716/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2005.09.004