Subsidization of substance use treatment: Comparison of methadone maintenance treatment and abstinence-based residential treatment in Iran

Abstract

Background: Subsidization is a policy to encourage the purchase and use of goods and services and to promote their affordability for the poor. The Welfare Organization of Iran subsidizes substance use treatment in order to increase coverage and adherence to treatment. Objectives: This study aimed to answer the following questions: is the model efficient? Has the policy resulted in increased coverage and higher adherence to substance use treatment? How could the model be improved? Methods: We compared two types of substance use treatments of abstinence-based residential program and outpatient methadone maintenance. Based on their severity of addiction and retention in treatment clients who benefited from subsidization were compared with other clients. Therefore, 109 clients, 78 from methadone maintenance and 31 from residential abstinence-based programs were interviewed. Results: Subsidization had an encouraging effect on clients to enter substance use treatment in both treatment programs (P = 0.001). However, we were unable to find evidence that subsidization helped retention in the treatment (P = 0.389), or that concomitant use of illegal substances in clients on methadone maintenance was lower (P = 0.500). Based on economic status of clients (P = 0.05) their criminal record (P = 0.001), length of use of substances (P = 0.05), and comorbid psychiatric conditions (P = 0.05), it was evident that assignment to subsidization in methadone maintenance services was significantly more reasonable, while it was almost random in abstinence-based residential facilities assignment. Conclusions: The current model of substance use treatment subsidization is not efficient. Addiction severity subscales and socioeconomic status of clients could be considered appropriate factors for assignment to the subsidization program.