title: Methadone medical maintenance in primary care. An implementation evaluation.
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 research setting.
  
  
  METHODS
  One-year program evaluation.
  
  
  METHODS
  A public hospital and a community opioid treatment program.
  
  
  METHODS
  Methadone patients with >1 year of clinical stability. Eleven generalist physicians and 4 hospital pharmacists.
  
  
  METHODS
  Regulatory exemptions were requested. Physicians and pharmacists were trained. Patients were transferred to the medical setting and permitted 1-month supplies of methadone.
  
  
  METHODS
  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 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.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. joem@u.washington.edu
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: T Ron
authors.initials: TR
authors.lastname: Jackson
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Schulman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.forename: Asaad
authors.initials: A
authors.lastname: Awan
authors.forename: Sonja
authors.initials: S
authors.lastname: Kapitan
authors.forename: Molly
authors.initials: M
authors.lastname: Carney
authors.forename: Lyndia C
authors.initials: LC
authors.lastname: Brumback
authors.forename: Dennis
authors.initials: D
authors.lastname: Donovan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D016320:Substance Abuse Treatment Centers; D014861:Washington
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone