***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Methadone maintenance treatment ( MMT ) has been successfully scaled up nationally in China . However , the program faces problems of poor attendance and high rates of continued drug use . We assessed whether a contingency management ( CM ) intervention implemented by MMT clinic staff could improve treatment attendance and drug abstinence . METHODS Eight MMT clinics in Guangdong province were r and omly selected and divided into two groups . A total of 126 participants ( 55 in urban clinics and 71 in rural clinics ) received CM  during a 12-week trial , 120 participants ( 83 in urban clinics and 37 in rural clinics ) received usual treatment ( UT )  . Participants in the CM group had the opportunity to draw for prizes contingent on attending treatment daily and testing negative for morphine . Clinic- and individual-level outcomes were compared between the intervention and control groups . RESULTS The retention rate and negative urine testing rate were 14.2 % ( P=0.010 ) and 10.7 % ( P<0.001 ) higher in the CM group compared to the UT group , respectively . Compared with participants who received UT , CM participants missed on average 7.3 fewer ( P=0.008 ) visits and were 1.91 ( 95 % CI : 1.53 - 2.39 ) times more likely to su bmi t a negative urine sample . All clinic- and individual- level effects of the intervention were observed at rural clinics , but the difference in retention rate between urban CM and UT clinics was not significant . CONCLUSION Although the frequency of monitoring and value of the incentives in this study was lower than in previous studies , the CM intervention significantly improved attendance and reduced drug use in China Abstract Objective : To evaluate an experimental heroin maintenance programme . Design : R and omised trial . Setting : Outpatient clinic in Geneva , Switzerl and . Subjects : Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments . Intervention : Patients in the experimental programme ( n=27 ) received intravenous heroin and other health and psychosocial services .  Control patients ( n=24 ) received any other conventional drug treatment ( usually methadone maintenance ) . Main outcome measures : Self reported drug use , health status ( SF-36 ) , and social functioning . Results : 25 experimental patients completed 6 months in the programme , receiving a median of 480 mg of heroin daily . One experimental subject and 10 control subjects still used street heroin daily at follow up ( difference 44 % ; 95 % confidence interval 16 % to 71 % ) . Health status scores that improved significantly more in experimental subjects were mental health ( 0.58 SD ; 0.07 to 1.10 ) , role limitations due to emotional problems ( 0.95 SD ; 0.11 to 1.79 ) , and social functioning ( 0.65 SD ; 0.03 to 1.26 ) . Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences . There were no benefits in terms of work , housing situation , somatic health status , and use of other drugs . Unexpectedly , only nine ( 38 % ) control subjects entered the heroin maintenance programme at follow up . Conclusions : A heroin maintenance programme is a feasible and clinical ly effective treatment for heroin users who fail in conventional drug treatment programmes . Even in this population , however , another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids AIMS This study aim ed to determine the relative effectiveness of 12 months of interim methadone ( IM ; supervised methadone with emergency counseling only for the first 4 months of treatment ) , st and ard methadone treatment ( SM ; with routine counseling ) and restored methadone treatment ( RM : routine counseling with smaller case-loads ) . DESIGN A r and omized controlled trial was conducted comparing IM , SM and RM treatment . IM lasted for 4 months , after which participants were transferred to SM . SETTING The study was conducted in two methadone treatment programs in Baltimore , MD , USA . PARTICIPANTS The study included 230 adult methadone patients newly admitted through waiting-lists . MEASUREMENTS We administered the Addiction Severity Index and a supplemental question naire  at baseline , 4 and 12 months post- baseline . Measurements included retention in treatment , self-reported days of heroin and cocaine use , criminal behavior and arrests and urine tests for heroin and cocaine metabolites . FINDINGS At 12 months , on an intent-to-treat basis , there were no significant differences in retention in treatment among the IM , SM and RM groups ( 60.6 % , 54.8 % and 37.0 % , respectively ) . Positive urine tests for the three groups declined significantly from baseline ( Ps < 0.001 and 0.003 , for heroin and cocaine metabolites , respectively ) but there were no significant group x time interactions for these measures . At least one arrest was reported by 30.6 % of the sample during the year , but there were no significant between-group effects . CONCLUSIONS Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin -- at least for the first 4 months of treatment OBJECTIVE The majority of drug addicts are polydrug dependent , and no effective pharmacological treatment is currently available for them . The authors studied the overall real-world effectiveness of naltrexone implant in this patient population . METHOD The authors assessed the effectiveness of a naltrexone implant in the treatment of coexisting heroin and amphetamine polydrug dependence in 100 heroin- and amphetamine-dependent out patients in a 10-week r and omized , double-blind , placebo-controlled trial . The main outcome measures were retention in the study , proportion of drug-free urine sample s , and improvement score on the Clinical Global Impressions Scale ( CGI ) . Analyses were conducted in an intent-to-treat model . RESULTS At week 10 , the retention rate was 52 % for patients who received a naltrexone implant and 28 % for those who received a placebo implant ; the proportions of drug-free urine sample s were 38 % and 16 % , respectively , for the two groups . On the CGI improvement item , 56 % of the patients in the naltrexone group showed much or very much improvement , compared with 14 % of those in the placebo group ( number needed to treat=3 ) . CONCLUSIONS Naltrexone implants result ed in higher retention in the study , decreased heroin and amphetamine use , and improved clinical condition for patients , thus providing the first evidence of an effective pharmacological treatment for this type of polydrug dependence Abstract Objective To determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment .  Design Two open label r and omised controlled trials . Setting Methadone maintenance programmes in six cities in the Netherl and s. Participants 549 heroin addicts . Interventions Inhalable heroin ( n = 375 ) or injectable heroin ( n = 174 ) prescribed over 12 months . Heroin ( maximum 1000 mg per day ) plus methadone ( maximum 150 mg per day ) compared with methadone alone ( maximum 150 mg per day ) . Psychosocial treatment was offered throughout . Main outcome measures Dichotomous , multidomain response index , including vali date d indicators of physical health , mental status , and social functioning . Results Adherence was excellent with 12 month outcome data available for 94 % of the r and omised participants . With intention to treat analysis , 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin ( response rate 49.7 % v 26.9 % ; difference 22.8 % , 95 % confidence interval 11.0 % to 34.6 % ) and in the trial of injectable heroin ( 55.5 % v 31.2 % ; difference 24.3 % , 9.6 % to 39.0 % ) . Discontinuation of the coprescribed heroin result ed in a rapid deterioration in 82 % ( 94/115 ) of those who responded to the coprescribed heroin . The incidence of serious adverse events was similar across treatment conditions . Conclusions Supervised coprescription of heroin is feasible , more effective , and probably as safe as methadone alone in reducing the many physical , mental , and social problems of treatment resistant heroin addicts Dropout and recidivism from  addiction treatment  has been found to be associated with individuals ' readiness for change . Motivation for treatment among participants entering the North American Opiate Medication Initiative ( NAOMI ) r and omized controlled trial , which compared heroin assisted treatment ( HAT ) to optimized methadone maintenance treatment ( MMT )  , was assessed . Through multivariate regression , we aim ed to determine whether baseline motivational status was predictive of four treatment outcomes : early dropout , 12-month retention , 12-month response to treatment , and time to discontinuation of treatment . Among the 251 out-of-treatment chronic opioid dependent patients recruited in Montreal , Quebec and Vancouver , British Columbia , 52 % reported having a high level of motivation for treatment .  HAT was statistically significantly more effective than  MMT  on each of the outcomes assessed . Baseline motivational status did not predict retention or time to discontinuation in either HAT or  MMT . However , while patients were retained in HAT regardless of motivational status , motivated patients showed a more favourable response to treatment in terms of decreases in crime and illicit drug use . These results suggest that HAT successfully retains opioid dependent patients who otherwise may not have been attracted into existing treatment options , and may enhance the odds of successful rehabilitation among patients motivated for treatment UNLABELLED This study examined the dose-related efficacy of disulfiram for treating cocaine dependence in methadone-stabilized cocaine dependent participants . DESIGN One hundred and sixty-one cocaine- and opioid-dependent volunteers were entered into a 14-week , double blind , r and omized , placebo-controlled clinical trial at two sites . METHODS Participants were stabilized on methadone during weeks 1 - 2 and received disulfiram at 0 , 62.5 , 125 or 250 mg/day during weeks 3 - 14 . All participants also received weekly cognitive behavioral therapy . Thrice-weekly urine sample s and weekly self-reported drug use assessment s were obtained . RESULTS Baseline subject characteristics , retention and drug use did not differ across groups . Outcome analyses were performed on those who participated beyond week 2 . Opioid-positive urine sample s and self-reported opioid use did not differ by treatment group . The prevalence of alcohol use was low prior to and during the trial and did not differ by treatment group . Cocaine-positive urines increased over time in the 62.5 and 125 mg disulfiram groups and decreased over time in the 250 mg disulfiram and placebo groups ( p < 0.0001 ) . Self-reported cocaine use increased in the 125 mg disulfiram group relative to the other three treatment groups ( p = 0.04 ) . CONCLUSIONS Disulfiram may be contraindicated for cocaine dependence at doses < 250 mg/day . Whether disulfiram at higher doses is efficacious in reducing cocaine use in dually cocaine and opioid dependent individuals needs to be determined OBJECTIVE The objective of this secondary analysis was to explore differences in baseline clinical characteristics and  opioid replacement therapy treatment outcomes by type ( heroin , opioid analgesic [ OA ] , or combined [ heroin and OA ] ) and route ( injector or non-injector ) of opioid use . METHOD A total of 1,269 participants ( 32.2 % female ) were r and omized to receive one of two study medications ( methadone or buprenorphine/naloxone [ BUP ] )  . Of these , 731 participants completed the 24-week active medication phase . Treatment outcomes were opioid use during the final 30 days of treatment ( among treatment completers ) and treatment attrition . RESULTS Non-opioid substance dependence diagnoses and injecting differentiated heroin and combined users from OA users . Non-opioid substance dependence diagnoses and greater heroin use differentiated injectors from non-injectors . Further , injectors were more likely to be using at end of treatment compared with non-injectors . OA users were more likely to complete treatment compared with heroin users and combined users . Non-injectors were more likely than injectors to complete treatment . There were no interactions between type of opioid used or injection status and treatment assignment ( methadone or BUP ) on either opioid use or treatment attrition . CONCLUSIONS Findings indicate that substance use severity differentiates heroin users from OA users and injectors from non-injectors . Irrespective of medication , heroin use and injecting are associated with treatment attrition and opioid misuse during treatment . These results have particular clinical interest , as there is no evidence of superiority of  BUP over methadone for treating OA users versus heroin users AIMS Previous research has reported that both contingency management ( CM ) and cognitive-behavioral therapy ( CBT ) are efficacious interventions for the treatment of stimulant abusers . The present study sought to directly compare the effectiveness of ( CM ) and ( CBT ) alone and in combination in reducing  stimulant use .  DESIGN R and omized clinical trial . PARTICIPANTS Stimulant-dependent individuals ( n = 171 ) . INTER 
    Output:
    
Consistent with prior research , methadone was associated with better retention than buprenorphine/naloxone .
Contingency management showed promise to increase retention , but other behavioral therapies to increase retention , such as supervision of medication consumption , or additional counseling , education , or support , failed to find differences between intervention and control conditions .