Stabilized, long-term methadone maintenance patients can be treated safely in medical office-based practices (methadone medical maintenance programs) without adverse effects and with high rates of treatment retention and improved satisfaction.
Most methadone-based treatment services are offered through specialized and federally certified Opioid Treatment Programs (OTPs). But treatment through these centers can be difficult to access, carries significant stigma, and in some states is simply not available (Merrill, 2002). In an effort to broaden treatment options for opiate addiction, methadone medical maintenance programs were initiated in experimental settings to allow OTP patients who are considered stable to get treatment from physicians in a general practice setting. Typically, methadone medical maintenance patients see their physicians once a month where they receive a one-month supply of medication, rather than going to a clinic more frequently (Salsitz et al., 2000). In 2001, the first methadone medical maintenance program was approved outside the experimental setting and within the existing regulatory structure (Merrill et al., 2005).
Several studies looking at the experience of stable methadone maintenance patients in office-based treatment programs have concluded that methadone medical maintenance can be an effective way to treat opioid dependence. A study examining 15 years of treatment in a New York City methadone medical maintenance found that of 158 patients who entered the program, 132 (83.5 percent) adhered to the program rules and proved to be treatable in an office-based setting (Salsitz et al., 2000). Researchers also have found that the simplified approach makes it easier for the patients receiving office-based treatment to deal with work and business situations and finish school than patients in traditional clinics (King, et al., 2002).
While treatment in an office-based setting is known to be effective, establishing a medical maintenance program can be a complex undertaking. For example, it can take a year or more to obtain the necessary regulatory exemptions required to offer methadone outside of a traditional clinic and training is needed for participating physicians and pharmacists (Merrill et al., 2005).