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Methadone medical maintenance in primary care. An implementation evaluation
Joseph O Merrill1, T Ron Jackson, Beryl A Schulman
1Department of Medicine, University of Washington, Seattle, WA, USA. joem@u.washington.edu
Journal of General Internal Medicine
|April 29, 2005
Summary
Methadone medical maintenance is feasible outside research settings, demonstrating good clinical outcomes for opioid addiction treatment. This approach addresses unmet medical needs and improves patient and physician satisfaction.
Area of Science:
- Addiction Medicine
- Public Health
- Pharmacology
Background:
- Methadone is an effective opioid addiction treatment, but regulatory hurdles limit its application.
- Methadone medical maintenance offers a pathway for stabilized patients within medical settings, yet research on non-experimental programs is limited.
Purpose of the Study:
- To assess the implementation and outcomes of the first methadone medical maintenance program established outside a research context.
Main Methods:
- A one-year program evaluation was conducted in a public hospital and community opioid treatment program.
- Participants included 11 generalist physicians, 4 hospital pharmacists, and methadone patients with over one year of clinical stability.
- Key interventions involved obtaining regulatory exemptions, training medical staff, and permitting patients to receive 1-month methadone supplies in a medical setting.
Main Results:
- Regulatory exemptions were secured after a 14-month process, paving the way for wider implementation.
- Thirty patients enrolled, with 28 retained for one year; two patients with opioid-positive urine tests were managed effectively.
- The program addressed previously unmet medical needs, improved Addiction Severity Index (ASI) scores (P=.02), and significantly enhanced patient and physician satisfaction and attitudes toward methadone maintenance (P=.007).
Conclusions:
- Establishing methadone medical maintenance outside research settings is complex but achievable.
- The program demonstrated feasibility and positive clinical outcomes, including improved patient well-being and more favorable physician perspectives on methadone treatment.