Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China

Abstract

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%–89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%–89% of the tapering phase increased the odds of heroin abstinence.