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Methadone medical maintenance in primary care

An implementation evaluation

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Abstract

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 1 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 physicia 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.

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References

  1. Dole VP. Implications of methadone maintenance for theories of narcotic addiction. JAMA. 1988;260:3025–9.

    Article  PubMed  CAS  Google Scholar 

  2. Effective medical treatment of opiate addiction. National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. JAMA. 1998;280:1936–43.

  3. Barnett PG, Hui SS. The cost-effectiveness of methadone maintenance. Mt Sinai J Med. 2000;67:365–74.

    PubMed  CAS  Google Scholar 

  4. Ball J. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York, NY: Springer-Verlag; 1991.

    Google Scholar 

  5. Sees KL, Delucchi KL, Masson C, et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283:1303–10.

    Article  PubMed  CAS  Google Scholar 

  6. Gossop M, Marsden J, Stewart D, Treacy S. Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Depend. 2001;62:255–64.

    Article  PubMed  CAS  Google Scholar 

  7. Rettig RA, Yarmolinsky A, eds. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995.

    Google Scholar 

  8. Merrill JO. Policy progress for physician treatment of opiate addiction. J Gen Intern Med. 2002;17:361–8.

    Article  PubMed  Google Scholar 

  9. Novick DM, Pascarelli EF, Joseph H, et al. Methadone maintenance patients in general medical practice. A preliminary report. JAMA. 1988;259:3299–302.

    Article  PubMed  CAS  Google Scholar 

  10. Novick DM, Joseph H. Medical maintenance: the treatment of chronic opiate dependence in general medical practice. J Subst Abuse Treat. 1991;8:233–9.

    Article  PubMed  CAS  Google Scholar 

  11. Novick DM, Richman BL, Friedman JM, et al. The medical status of methadone maintenance patients in treatment for 11–18 years. Drug Alcohol Depend. 1993;33:235–45.

    Article  PubMed  CAS  Google Scholar 

  12. Salsitz EA, Joseph H, Frank B, et al. Methadone medical maintenance (MMM): treating chronic opioid dependence in private medical practice—a summary report (1983–1998). Mt Sinai J Med. 2000;67:388–97.

    PubMed  CAS  Google Scholar 

  13. Schwartz RP, Brooner RK, Montoya ID, Currens M, Hayes M. A 12-year follow-up of a methadone medical maintenance program. Am J Addict. 1999;8:293–9.

    Article  PubMed  CAS  Google Scholar 

  14. King VL, Stoller KB, Hayes M, et al. A multicenter randomized evaluation of methadone medical maintenance. Drug Alcohol Depend. 2002;65:137–48.

    Article  PubMed  Google Scholar 

  15. Senay EC, Barthwell A, Marks R, Bokos PJ. Medical maintenance: an interim report. J Addict Dis. 1994;13:65–9.

    Article  PubMed  CAS  Google Scholar 

  16. McLellan AT, Kushner H, Metzger D, et al. The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat. 1992;9:199–213.

    Article  PubMed  CAS  Google Scholar 

  17. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  18. Fiellin DA, O’Connor PG, Chawarski M, Pakes JP, Pantalon MV, Schottenfeld RS. Methadone maintenance in primary care: a randomized controlled trial. JAMA. 2001;286:1724–31.

    Article  PubMed  CAS  Google Scholar 

  19. Caplehorn JR, Irwig L, Saunders JB. Attitudes and beliefs of staff working in methadone maintenance clinics. Subst Use Misuse. 1996;31:437–52.

    PubMed  CAS  Google Scholar 

  20. Caplehorn JR, Hartel DM, Irwig L. Measuring and comparing the attitudes and beliefs of staff working in New York methadone maintenance clinics. Subst Use Misuse. 1997;32:399–413.

    Article  PubMed  CAS  Google Scholar 

  21. McNeely J, Drucker E, Hartel D, Tuchman E. Office-based methadone prescribing: acceptance by inner-city practitioners in New York. J Urban Health. 2000;77:96–102.

    Article  PubMed  CAS  Google Scholar 

  22. Lepay D, Clark HW. Federal Advisory on Methadone Medical Maintenance Exemptions. Washington, DC: Department of Health and Human Services; 2000

    Google Scholar 

  23. Senay EC, Barthwell AG, Marks R, Bokos P, Gillman D, White R. Medical maintenance: a pilot study. J Addict Dis. 1993;12:59–76.

    Article  PubMed  CAS  Google Scholar 

  24. Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA. 2001;286:1715–23.

    Article  PubMed  CAS  Google Scholar 

  25. Laine C, Hauck WW, Gourevitch MN, Rothman J, Cohen A, Turner BJ. Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs. JAMA. 2001;285:2355–62.

    Article  PubMed  CAS  Google Scholar 

  26. Willenbring ML, Olson DH. A randomized trial of integrated outpatient treatment for medically ill alcoholic men. Arch Intern Med. 1999;159:1946–52.

    Article  PubMed  CAS  Google Scholar 

  27. Friedmann PD, Zhang Z, Hendrickson J, Stein MD, Gerstein DR. Effect of primary medical care on addiction and medical severity in substance abuse treatment programs. J Gen Intern Med. 2003;18:1–8.

    Article  PubMed  Google Scholar 

  28. Caplehorn JR, Lumley TS, Irwig L. Staff attitudes and retention of patients in methadone maintenance programs. Drug Alcohol Depend. 1998;52:57–61.

    Article  PubMed  CAS  Google Scholar 

  29. Weinrich M, Stuart M. Provision of methadone treatment in primary care medical practices: review of the Scottish experience and implications for US policy. JAMA. 2000;283:1343–8.

    Article  PubMed  CAS  Google Scholar 

  30. Hutchinson SJ, Taylor A, Gruer L, et al. One-year follow-up of opiate injectors treated with oral methadone in a GP-centred programme. Addiction. 2000;95:1055–68.

    Article  PubMed  CAS  Google Scholar 

  31. Gossop M, Stewart D, Browne N, Marsden J. Methadone treatment for opiate dependent patients in general practice and specialist clinic settings: outcomes at 2-year follow-up. J Subst Abuse Treat. 2003;24:313–21.

    Article  PubMed  Google Scholar 

  32. Brands J, Brands B, Marsh D. The expansion of methadone prescribing in Ontario, 1996–1998. Addict Res. 2000;8:485–96.

    Google Scholar 

  33. Fiellin DA, O’Connor PG. Clinical practice. Office-based treatment of opioid-dependent patients. N Engl J Med. 2002;347:817–23.

    Article  PubMed  Google Scholar 

  34. Opioid drugs in maintenance and detoxification treatment of opiate addiction; Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. Final rule. Fed Regist. 2001;66:4076–102.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, University of Washington, Seattle, WA, USA

    Joseph O. Merrill MD, MPH, Beryl A. Schulman PhD, MSW & Lyndia C. Brumback PhD

  2. Department of Social Work, University of Washington, Seattle, WA, USA

    T. Ron Jackson MSW

  3. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Andrew J. Saxon MD & Dennis Donovan PhD

  4. Department of Pharmacy, University of Washington, Seattle, WA, USA

    Asaad Awan Pharm D & Sonja Kapitan Pharm D, MPH

  5. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Lyndia C. Brumback PhD

  6. Department of Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA

    Joseph O. Merrill MD, MPH, Beryl A. Schulman PhD, MSW, Molly Carney PhD & Dennis Donovan PhD

  7. Center for AIDS Research, University of Washington, Seattle, WA, USA

    Lyndia C. Brumback PhD

Authors
  1. Joseph O. Merrill MD, MPH
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  2. T. Ron Jackson MSW
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  3. Beryl A. Schulman PhD, MSW
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  4. Andrew J. Saxon MD
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  5. Asaad Awan Pharm D
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  6. Sonja Kapitan Pharm D, MPH
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  7. Molly Carney PhD
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  8. Lyndia C. Brumback PhD
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  9. Dennis Donovan PhD
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Corresponding author

Correspondence to Joseph O. Merrill MD, MPH.

Additional information

This work was assisted by a grant from the Robert Wood Johnson Foundation Substance Abuse Policy Research Program (RWJF grant 34895).

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Merrill, J.O., Jackson, T.R., Schulman, B.A. et al. Methadone medical maintenance in primary care. J GEN INTERN MED 20, 344–349 (2005). https://doi.org/10.1111/j.1525-1497.2005.04028.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.04028.x

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