Recovery-oriented methadone maintenance (ROMM) is an approach to the treatment of opioid addiction that combines medication and a sustained menu of professional and peer-based recovery support services to assist patients and
families in initiating and maintaining long-term addiction recovery.


Excerpts from this monograph...

"The regulation and mass diffusion of MM in the 1970s and 1980s was accompanied by changes in treatment philosophy and clinical protocols. The most significant of these changes in terms of recovery orientation included a shift in emphasis from personal recovery to reduction of social harm; increased preoccupation with regulatory compliance; widening variation in the quality of MM programs; the reduction of average methadone doses to subtherapeutic levels; arbitrary limits on the length of MM treatment; pressure on patients to taper and end MM treatment; the erosion of ancillary medical, psychiatric, and social services; and a decreased emphasis on therapeutic alliance between MM staff and MM patients. The definition of recovery during this period shifted from a focus on global health and functioning to an almost exclusive preoccupation with abstinence—then defined as including cessation of methadone pharmacotherapy. The public face of MM became defined by the worst MM clinics and the least stabilized MM patients."

Trends in MM (Methadone Maintenance)

"Two trends are reshaping the future of MM in the United States: 1) a clearer articulation of addiction as a chronic disorder that is best treated through methods used to manage other chronic disorders,and 2) the emergence of recovery as an organizing paradigm for the addictions field. If sustained these trends will profoundly change the nature of all addiction treatment, including MM treatment."


Defining Recovery within the Context of MM

"Controversy and stigma continue to surround the use of methadone maintenance as a medical treatment of opioid addiction, in spite of more than four decades’ worth of scientific evidence of its effectiveness. Methadone patients continue to be socially marginalized, and their recovery status continues to be debated—even within the professional field of addiction treatment and within communities of recovery. The question of the recovery status of methadone patients cannot be answered without a clear understanding of what constitutes recovery from opioid addiction. The definition of recovery applied to the patient in medication-assisted recovery from opioid addiction
should be the same as that applied to recovery from any other substance use disorder."

"Recovery management (RM) is a philosophical framework for organizing addiction treatment services aimed at early pre-recovery identification and engagement, recovery initiation and stabilization, long-term recovery maintenance, and enhancement of quality of life for individuals and families affected by severe substance use disorders.5 Recovery-oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to sustain long-term recovery for individuals and families impacted by severe substance use disorders. The “system” in ROSC is not a local, state, or federal treatment agency but a macro level organization of a community, a state, or a nation."
RECENT GROWTH OF METHADONE MAINTENANCE
"The number of patients admitted to OTPs in the United States grew dramatically between 1998 and 2008—influenced by the growth in for-profit OTPs and new patterns of opioid addiction, e.g., increased addiction to pharmaceutical opioids. There are now 1,203 opioid treatment programs in 46 states (and the District of Columbia, U.S. Virgin Islands, American Samoa, and Puerto Rico), treating more than 260,000 patients on any given day.134 A 2009 analysis provides the latest profile of OTPs in the United States":

• OTPs constitute only 8% of all U.S. addiction treatment facilities, but OTP patients constitute
23% of all patients in addiction treatment.
• 67% of OTPs serve only patients in medication-assisted treatment—reflecting the isolation of
OTPs and their patients from the mainstream treatment system.
• 50% of OTPs are operated by for-profit organizations.
• Of 265,716 patients in OTP treatment in 2008, 99% were treated with methadone, and 1%
were treated with buprenorphine.
• Half of all OTP patients pay out-of-pocket for their own treatment, at an average annual cost
of $4,176 per year.
• 40% of OTP patients in the United States have been in methadone maintenance treatment for
more than two years.135