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Abstract

Objective:

The authors conducted a scoping review to survey the evidence landscape for studies that assessed outcomes of treating patients with opioid use disorder with methadone in office-based settings.

Methods:

Ovid MEDLINE and the Cochrane Database of Systematic Reviews were searched, and reference lists were reviewed to identify additional studies. Studies were eligible if they focused on methadone treatment in office-based settings conducted in the United States or other highly developed countries and reported outcomes (e.g., retention in care). Randomized trials and controlled observational studies were prioritized; uncontrolled and descriptive studies were included when stronger evidence was unavailable. One investigator abstracted key information, and a second verified data. A scoping review approach broadly surveyed the evidence, and therefore study quality was not rated formally.

Results:

Eighteen studies of patients treated with office-based methadone were identified, including six trials, eight observational studies, and four additional articles discussing use of pharmacies to dispense methadone. Studies on office-based methadone treatment, including primary care-based dispensing, were limited but consistently found that stable methadone patients valued office-based care and remained in care with low rates of drug use; outcomes were similar compared with stable patients in regular care. Office-based methadone treatment was associated with higher treatment satisfaction and quality of life. Limitations included underpowered comparisons and small samples.

Conclusions:

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. Research should assess the feasibility of office-based care for less stable patients.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 804 - 817
PubMed: 34315284

History

Received: 29 October 2020
Revision received: 27 February 2021
Accepted: 22 March 2021
Published online: 28 July 2021
Published in print: September 01, 2021

Keywords

  1. Methadone Therapy
  2. Opioid Use Disorder
  3. Office-Based Methadone
  4. Pharmacy Methadone Dispensing

Authors

Details

Dennis McCarty, Ph.D. [email protected]
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Christina Bougatsos, M.P.H.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Brian Chan, M.D., M.P.H.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Kim A. Hoffman, Ph.D.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Kelsey C. Priest, M.D., Ph.D.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Sara Grusing, B.A.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)
Roger Chou, M.D.
Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland (McCarty, Bougatsos, Chan, Grusing, Chou); Portland State University School of Public Health, Oregon Health and Science University, Portland (McCarty, Hoffman); Department of Medicine, Oregon Health and Science University School of Medicine, Portland (Chan); and Department of Psychiatry, University of Pittsburg (Priest)

Notes

Send correspondence to Dr. McCarty ([email protected]).

Competing Interests

Drs. McCarty and Hoffman have served as investigators on NIH-supported trials using donated medications from Alkermes and Indivior. The other authors report no financial relationships with commercial interests.

Funding Information

Supported by an award from Arnold Ventures (award 20-04132) and the National Institute on Drug Abuse (grants UH3 DA044831 and UG1 DA015815 to Drs. McCarty and Hoffman and grant F30 DA 044700 to Dr. Priest).

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