Office-based methadone treatment has been linked with improved outcomes for patients with opioid-use disorder who are stable, according to research published in the American Journal of Psychiatry.
In order to dispense methadone, opioid treatment programs must be federally certified in treating patients with opioid-use disorder, which limits access to care, researchers reported. They therefore conducted a scoping study to evaluate the benefits and risks of office-based methadone treatment (methadone medical maintenance) and pharmacy dispensing.
They selected 6 randomized trials, 8 observational studies, and 4 descriptive studies involving patients treated with office-based methadone after searching Ovid MEDLINE and the Cochrane Database of Systematic Reviews through July 2020.
US-based clinical trials that compared patients who underwent medical methadone treatment or office-based methadone agonist therapy with patients who continued treatment as usual in opioid treatment programs had similar or higher rates of measures of success such as urine screens, program completion, and satisfaction with treatment at 6 months and after 12 months.
A French study (n=221) found similar rates of retention and abstinence care in both specialty care (methadone clinic) and primary care (office-based setting). In an Australian study (n=139), heroin users and stable methadone patients who received buprenorphine reported similar heroin use and retention in care in both office-based settings with pharmacy dispensing and a methadone clinic. An Irish study found that patients in primary care were twice as likely as patients in methadone clinics to complete a full year in a program.
In the 4 US studies included that compared pharmacy dispensing of methadone with office dispensing, outcomes “appeared to be similar,” the researchers reported. A UK study found methadone deaths decreased and methadone prescribing increased following participation in an office-based methadone treatment program with pharmacy dispensing. Census tract data analyses found that patients traveled longer to reach opioid treatment programs than to pharmacies.
“Limited research suggests that office-based methadone treatment and pharmacy dispensing could enhance access to methadone treatment for patients with opioid use disorder without adversely affecting patient outcomes and, potentially, inform modifications to federal regulations,” the researchers said.
Expanding access to methadone services may also address racial disparities, the researchers reported.
Limitations of the study included small sample sizes and lack of generalizability of outcomes of studies that were conducted more than 20 years ago.
McCarty D, Bougatsos C, Chan B, et al. Office-based methadone treatment for opioid use disorder and pharmacy dispensing: a scoping review. Am J Psychiatry. 2021;178(9):804-817. doi:10.1176/appi.ajp.2021.20101548