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Integrating Methadone Services Into Primary Care in Ukraine: Two-Year Outcomes From a Randomized Trial.
Eteri Machavariani1, Denise Esserman2, Kostyantyn Dumchev3
1Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, and Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, and New York University School of Global Public Health, New York University, New York, New York (E.M.).
Annals of Internal Medicine
|December 8, 2025
Summary
Integrating methadone treatment into primary care settings improved guideline-concordant health care for opioid use disorder (OUD) patients. This approach enhanced quality health indicator scores without negatively impacting methadone retention rates.
Area of Science:
- Public Health
- Addiction Medicine
- Health Services Research
Background:
- Opioid use disorder (OUD) presents significant public health challenges globally, particularly in low- and middle-income countries where access to opioid agonist therapy (OAT) is restricted.
- Integrating OAT into primary care settings offers a potential solution to expand access and improve management of co-occurring conditions, yet provider hesitancy remains a barrier.
Purpose of the Study:
- To compare healthcare utilization among individuals with OUD receiving methadone in specialty clinics versus primary care centers in Ukraine.
- To evaluate the effectiveness of integrating methadone treatment into primary care settings using a telementoring model.
Main Methods:
- A randomized controlled trial involving 1459 adults with OUD across 13 Ukrainian cities.
- Participants were allocated 2:1 to receive methadone in primary care settings with telementoring or standard specialty clinic care.
- The primary outcome was the difference in composite quality health indicator (QHI) scores at 24 months, assessing access to guideline-concordant services.
Main Results:
- Primary care integration resulted in significantly higher composite QHI scores compared to specialty clinics (mean difference of 9.1 percentage points).
- Improvements were observed in both primary care QHI (12.3 percentage points) and specialty care QHI (5.2 percentage points).
- Methadone treatment retention at 24 months was comparable between groups (67.2% in primary care vs. 64.7% in specialty clinics).
Conclusions:
- Integrating methadone treatment into primary care settings enhances adherence to guideline-concordant healthcare services for individuals with OUD.
- This model effectively expands access to care without compromising methadone retention or overall treatment quality.
- The findings support primary care-based OAT as a viable strategy to improve healthcare delivery for OUD in diverse settings.
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