Methadone medical maintenance in primary care - An implementation evaluation

BACKGROUND: Methadone is effective treatment for opioid addiction. but regulations restrict its use. Methadone medical maintenance treats stabilized methadone patients in a medical setting, but only experimental programs have been studied. OBJECTIVE: To evaluate the implementation of the first methadone medical maintenance program established outside a reseach setting. DESIGN. One-year program evaluation. SETTING: A public hospital and a community opioid treatment program. PARTICIPANTS: Methadone patients with >1 year of clinical stability. Eleven generalist physicians and 4 hospital pharmacists. INTERVENTIONS: Regulatory exemptions were requested. Physicians and pharmacists were trained. Patients were transferred to the medical setting and permitted 1-month supplies of methadone. MEASUREMENTS. Patient eligibility and willingness to enroll. treatment retention. urine toxicology results, change in addiction severity and functional status, medical services provided, patient and physician satisfaction, and physician attitudes toward methadone maintenance. RESULTS: Regulatory exemptions were obtained after a 14-month process, and the program was cited in federal policy as acceptable for widespread implementation. Forty-nine of 684 patients (7.2%) met stability criteria, and 30 enrolled. Twenty-eight were retained for I year. and 2 transferred to other programs. Two patients had opioid-positive urine tests and were managed in the medical setting. Previously unmet medical needs were addressed, and the Addiction Severity Index [ASI) medical composite score improved over time (P=.02). Patient and physician satisfaction were high. and physician attitudes toward methadone maintenance treatment became more positive (P=.007). CONCLUSIONS: Methadone medical maintenance is complex to arrange but feasible outside a research setting, and can result in good clinical outcomes.