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Methadone for opioid use disorder for adults post-release

Adult Criminal Justice
Benefit-cost methods last updated December 2023.  Literature review updated April 2021.
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Methadone is an opiate agonist used to treat opiate use disorder. Methadone allows euphoric effects of opiates while preventing patients from developing a tolerance or from experiencing withdrawal symptoms when they stop taking the drug. Ultimately, it is intended to reduce cravings and prevent relapse.

Methadone-maintenance treatment (a combination of behavioral therapy, counseling, and methadone) and methadone-only treatments are typically administered weekly for 3 months. Patients in our analysis meet the criteria for opioid dependence and are on some form of criminal justice supervision (either parole or probation) following a release from jail or prison. Patients in the comparison condition receive either no methadone or usual treatment (i.e., drug treatment counseling).
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). 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 $223 Benefits minus costs ($32,220)
Participants ($270) Benefit to cost ratio ($0.47)
Others $693 Chance the program will produce
Indirect ($10,954) benefits greater than the costs 0%
Total benefits ($10,308)
Net program cost ($21,912)
Benefits minus cost ($32,220)

^WSIPP’s benefit-cost model does not monetize this outcome.

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. See Estimating Program Effects Using Effect Sizes for additional information.

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 Treatment age 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
Technical violations^
Violations of the conditions of an individual’s terms of probation, parole, or supervision.
 35 1 92 -0.065 0.226 35 0.000 0.000 36 -0.164 0.472
Alcohol use disorder
Clinical diagnosis of alcohol use disorder or symptoms measured on a validated scale.  
 35 1 128 0.247 0.267 35 0.000 0.000 36 0.247 0.354
Illicit drug use disorder
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 35 3 211 0.019 0.186 35 0.000 0.000 36 0.186 0.672
Cannabis use disorder
Clinical diagnosis of cannabis use disorder or symptoms measured on a validated scale.
35 1 128 0.000 0.216 35 0.000 0.000 36 0.000 1.000
Emergency department visits
Whether someone visited the emergency department, or the number of times they visited the emergency department.
35 1 128 -0.089 0.205 35 0.000 0.000 36 -0.089 0.665
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 35 2 220 -0.083 0.155 35 0.000 0.000 36 -0.121 0.435
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system $347 $0 $699 $173 $1,219
Alcohol use disorder Labor market earnings associated with alcohol abuse or dependence ($111) ($263) $0 $0 ($374)
Property loss associated with alcohol abuse or dependence $0 ($1) ($2) $0 ($2)
Illicit drug use disorder Health care associated with illicit drug abuse or dependence ($20) ($3) ($21) ($10) ($54)
Mortality associated with illicit drugs ($3) ($7) $0 ($167) ($177)
Emergency department visits Health care associated with emergency department visits $11 $3 $16 $6 $36
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($10,956) ($10,956)
Totals $223 ($270) $693 ($10,954) ($10,308)
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $15,060 2004 Present value of net program costs (in 2022 dollars) ($21,912)
Comparison costs $0 2004 Cost range (+ or -) 50%
We use the per-patient monthly cost of providing methadone treatment ($1,255) in Nordlund, D.J., Estee, S., Mancuso, D., & Felver, B. (2004). Methadone treatment for opioid 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. The costs calculations include costs of medication, dispensing, toxicology screens, medical care related to methadone treatment, and administration. We assume an average treatment period of 12 months to reflect the time for which we model benefits. We multiply the treatment period by the patient per-month cost to calculate the total per-patient cost of methadone treatment.
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

Citations Used in the Meta-Analysis

Brinkley-Rubinstein, L., McKenzie, M., Macmadu, A., Larney, S., Zaller, N., Dauria, E., & Rich, J. (2018). A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug and Alcohol Dependence, 184, 57-63.

Farrell-Macdonald, S., MacSwain, M.-A., Cheverie, M., Tiesmaki, M., & Fischer, B. (2014). Impact of Methadone maintenance treatment on women offenders' post-release recidivism. European Addiction Research, 20(4), 192-199.

Kinlock, T.W., Gordon, M.S., Schwartz, R.P., Fitzgerald, T.T., & O’Grady, K.E. (2009). A randomized clinical trial of Methadone maintenance for prisoners: Results at twelve-months post-release. Journal of Substance Abuse Treatment, 37(3), 277-285.