Safety, Efficacy, and Feasibility of Office-based Prescribing and Community Pharmacy Dispensing of Methadone

Objective: This article is the third in a series on office-based methadone treatment in primary care settings in conjunction with community pharmacies and social work. The study purpose is to examine the safety, efficacy, and feasibility of a physician office based, community pharmacy, and social work (OBP/CPD) model of care as compared to routine methadone maintenance treatment in a program (MMTP). Methods: A 1 year pilot study was conducted from September 2003 to December 2004. Twenty-six stable female methadone maintenance patients were randomized to either methadone maintenance at a physician office, community pharmacy, and social work (n = 14) or routine care at a MMTP (n = 12). The main outcome measures are retention in methadone treatment and illicit drug use compared between the 2 groups in an equivalency design. Results: Retention in methadone treatment during the 12-month period of pharmacy dispensing was 100%, as compared with one in the control group. Three of 13 (23%) patients in OBP/CPD had evidence of illicit opiate use during the study period, compared with 7 of 9 (78%) MMTP patients. Three of 13 (23%) OBP/CPD patients compared with 4 of 9(44%) MMTP patients had urine toxicology positive for cocaine. One of 13 (8%) OBP/CPD patients compared with 4 of 9 ( 44%) MMTP patients had urine toxicology results positive for benzodiazepines. Conclusions: This study represents the first study of office-based methadone maintenance in conjunction with community pharmacy dispensing of methadone that has been directly compared with usual care in an MMTP. Findings support the safety, efficacy, and feasibility of office-based prescribing in conjunction with community pharmacy dispensing and social work treatment of methadone to expand options for methadone maintenance treatment for stable patients.