Stable Methadone Patients Can Successfully Continue Treatment in a Primary Care Physician's Office, Yale Researchers Find

When stable methadone patients, who were formerly addicted to heroin and other narcotics, switch from a narcotic treatment program to a physician’s office for continuing methadone maintenance treatment, they become more accepting of the treatment and they continue to do well, Yale researchers have found.

“The results show that methadone maintenance by office-based primary care physicians is a feasible and effective treatment for stable methadone patients,” said lead author David A. Fiellin, M.D., assistant professor of medicine at Yale School of Medicine. “The study results could also expand access to treatment for some of the hundreds of thousands of people the treatment facilities can’t accommodate.”

Published in today’s issue of the Journal of the American Medical Association, the six-month study looked at 46 men and women who were randomly assigned to either remain at their narcotic treatment program or to receive treatment in a physician’s office. Twenty-two patients were assigned to specially trained general internists and 24 continued treatment at a methadone clinic. Fiellin and his team found that 82 percent of patients assigned to a physician’s office remained clinically stable during the six months. They further found that 73 percent of the patients were more satisfied with treatment in the physicians’ offices, and the physicians felt confident and responded well to providing this kind of treatment.

“There were no differences over time within or between the groups in functional status or use of health, legal or social services,” said Fiellin. “In this study, we also found that by performing hair testing for certain substances at the beginning of treatment, we were able to identify the patients that are more likely to have a relapse.”

Fiellin said the study’s results highlight a possible solution to the problem of providing treatment for the estimated 800,000 patients that need it. “Opioid dependence and heroin addiction is at a crisis level in America,” he said. “We need to provide treatment for over 800,000 patients and because of space limitations, only 170,000 are enrolled in formal treatment programs. We need to expand locations where patients can receive treatment, and a primary care physician’s office could be one such location. It would also allow us to take patients who have done well for a period of time and move them to a less structured environment, opening up slots for new patients to enter into treatment.”

Other researchers on the study include Patrick G. O’Connor, M.D., Marek Chawarski, Michael V. Pantalon and principal investigator Richard Schottenfeld, M.D. of Yale; and Juliana P. Pakes of Harvard Medical School.

The study was funded by the Center for Substance Abuse Treatment and the State of Connecticut Department of Mental Health and Addiction Services.

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