Office-based treatment may enhance methadone access for those with opioid use disorder

Using methadone to treat opioid use disorder in office-based settings may enhance access to this treatment without adversely affecting patient outcomes, according to results of a scoping review published in American Journal of Psychiatry.

“Office-based methadone treatment (also referred to as ‘methadone medical maintenance’) for stable patients can occur with SAMHSA-approved exceptions if the physician’s office is affiliated with an [opioid treatment program],” Dennis McCarty, PhD, of the department of medical informatics and clinical epidemiology at Oregon Health & Science University, and colleagues wrote. “Routine use of office-based methadone treatment, however, is uncommon. To assess the harms, benefits and feasibility of office-based methadone treatment, we conducted a scoping review to systematically survey the evidence landscape and highlight studies that assessed outcomes of treating patients with opioid use disorder with methadone in primary care settings and other office-based settings and/or with pharmacy dispensing for patients.”

The researchers searched two databases and reviewed reference lists to identify additional studies. They included those that evaluated methadone treatment in office-based settings and were conducted in the U.S. or other highly developed countries and reported outcomes, such as retention in care. They prioritized randomized trials and controlled observational studies; when stronger evidence was not available, they included uncontrolled and descriptive studies.

McCarty and colleagues analyzed data from 18 total studies that included patients treated with office-based methadone. Of these, six were trials, eight were observational studies and four were descriptive studies. Although studies on office-based methadone treatment, including primary care-based dispensing, were limited, the researchers reported that they consistently showed stable methadone patients valued office-based care and remained in care with low drug use rates. These patients had similar outcomes compared with stable patients in regular care. McCarty and colleagues noted an association between office-based methadone treatment and higher treatment satisfaction and quality of life, as well as several limitations, including underpowered comparisons and small samples.

“Research is needed on office-based methadone treatment for patients new to care,” McCarty and colleagues wrote. “Office-based methadone treatment and pharmacy dispensing could enhance access to methadone treatment for patients with opioid use disorder.”