Washington State Institute for Public Policy
Methadone maintenance for opioids
Substance Abuse: Substance Abuse Medication-assisted Treatment
Benefit-cost estimates updated December 2016.  Literature review updated December 2016.
Methadone is an opiate substitution treatment used to treat opioid dependence. It is a synthetic opioid that blocks the effects of opiates, reduces withdrawal symptoms, and relieves cravings. Methadone is a daily medication dispensed in outpatient clinics that specialize in methadone treatment and is often used in conjunction with behavioral counseling approaches. The studies included in our analysis evaluated methadone maintenance rather than short-term detoxification or stabilization. We excluded studies with treatment dosages below standard guidances (< 50 mg/day).
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $1,153 Benefits minus costs $4,554
Participants $1,623 Benefit to cost ratio $2.22
Others $469 Chance the program will produce
Indirect $5,036 benefits greater than the costs 89 %
Total benefits $8,280
Net program cost ($3,727)
Benefits minus cost $4,554
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $3 $0 $9 $1 $13
Labor market earnings associated with opioid drug abuse or dependence $691 $1,523 $0 $6,644 $8,858
Health care associated with opioid drug abuse or dependence $459 $100 $460 $226 $1,245
Adjustment for deadweight cost of program $0 $0 $0 ($1,835) ($1,835)
Totals $1,153 $1,623 $469 $5,036 $8,280
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $3,613 2012 Present value of net program costs (in 2015 dollars) ($3,727)
Comparison costs $0 2012 Cost range (+ or -) 20 %
We estimate the per-participant costs of providing methadone in addition to standard substance abuse treatment for 12 months. Costs reflect the average of costs reported in numerous cost-effectiveness studies (Rosenhack and Kosten, 2001; Jones et al., 2009; Nordlund et al., 2004; Masson et al, 2004). Costs included vary by study but generally include costs of medication, dispensing, toxicology screens, medical care related to methadone treatment, and when available, costs of equipment, administration, and clinic space. Jones, E.S., Moore, B.A., Sindelar, J.L., O’Connor, P.G., Schottenfeld, R.S., & Fiellin, D.A. (2009). Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients. Drug and Alcohol Dependence, 99(1), 132-140. Masson, C.L., Barnett, P.G., Sees, K.L., Delucchi, K.L., Rosen, A., Wong, W., & Hall, S.M. (2004). Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification. Addiction, 99(6), 718-726. Nordlund, D.J., Estee, S., Mancuso, D., & Felver, B. (2004). Methadone treatment for opiate addiction lowers health care costs and reduces arrests and convictions. Olympia, Wash.: Washington State Dept. of Social and Health Services, Research and Data Analysis Division. Rosenheck, R., & Kosten, T. (2001). Buprenorphine for opiate addiction: potential economic impact. Drug and Alcohol Dependence, 63(3), 253-262. Treatment as usual in this case may include counseling or other services.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Opioid drug abuse or dependence 8 623 -0.945 0.304 37 0.000 0.000 38 -0.945 0.002
Crime 3 259 -0.672 0.112 37 0.000 0.000 38 -0.672 0.001
Hospitalization 3 286 0.242 0.464 37 0.000 0.000 38 0.242 0.602
Alcohol use 2 223 -0.281 0.250 37 0.000 0.000 38 -0.281 0.261
Death 3 137 -0.236 0.261 37 0.000 0.000 38 -0.236 0.365
STD risky behavior 3 492 -0.559 0.242 37 0.000 0.000 38 -0.559 0.021
Citations Used in the Meta-Analysis

Bale, R.N., Van, S.W.W., Kuldau, J.M., Engelsing, T.M., Elashoff, R.M., & Zarcone, V.P.J. (1980). Therapeutic communities vs methadone maintenance. A prospective controlled study of narcotic addiction treatment: design and one-year follow-up. Archives of General Psychiatry, 37, 2, 179-193.

Dolan, K.A., Shearer, J., MacDonald, M., Mattick, R.P., Hall, W., & Wodak, A.D. (2003). A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Drug and Alcohol Dependence, 72(1), 59-65.

Gronbladh, L. & Gunne, L. (1989). Methadone-assisted rehabilitation of Swedish heroin addicts. Drug and Alcohol Dependence, 24(1), 31-37.

Gruber, V.A., Delucchi, K.L., Kielstein, A., & Batki, S.L. (2008). A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug and Alcohol Dependence, 94, 1, 199-206.

Kinlock, T., Gordon, M., Schwartz, R., O'Grady, K., Fitzgerald, T., & Wilson, M. (2007). A randomized clinical trial of methadone maintenance for prisoners: Results at 1-month post-release. Drug and Alcohol Dependence, 91(2-3), 220-227.

Newman, R., & Whitehill, W. (1979). Double-blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong. The Lancet, 314(8141), 485-488.

Schwartz, R.P., Highfield, D.A., Jaffe, J.H., Brady, J.V., Butler, C.B., Rouse, C.O., Callaman, J.M., ... Battjes, R.J. (2006). A randomized controlled trial of interim methadone maintenance. Archives of General Psychiatry, 63(1), 102-9.

Schwartz, R.P., Jaffe, J.H., Highfield, D.A., Callaman, J.M., & O'Grady, K.E. (2007). A randomized controlled trial of interim methadone maintenance: 10-Month follow-up. Drug and Alcohol Dependence, 86(1), 30-36.

Strain, E.C., Stitzer, M. L., Liebson, I.A., & Bigelow, G.E. (1993). Dose-response effects of methadone in the treatment of opioid dependence. Annals of Internal Medicine, 119(1), 23-27.

Vanichseni, S., Wongsuwan, B., Choopanya, K., & Wongpanich, K. (1991). A controlled trial of methadone maintenance in a population of intravenous drug users in Bangkok: Implications for prevention of HIV. International Journal of the Addictions, 26(12), 1.

Wilson, M.E., Schwartz, R.P., O'Grady, K.E., & Jaffe, J.H. (2010). Impact of interim methadone maintenance on HIV risk behaviors. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 87(4), 586-591.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov