US-based methadone medical maintenance programs may fall short when it comes to enhancing access to addiction treatment because under the current regulatory structure, only a small proportion of methadone maintenance patients qualify for office-based services.
Its important to consider that in the US, patients treated in one of the relatively small number of office-based methadone programs may not be representative of all those with opioid dependence. Thus, lessons learned for their experience in office-based treatment may have limits.
The patients now allowed to enter methadone medical maintenance programs are those who are considered stable, meaning they have been successfully receiving treatment at a methadone clinic for over a year (Merrill et al., 2005). And while the patients selected to participate in office-based programs may be happier receiving methadone through a physicians office, they probably would have continued to function well in a traditional clinic setting (King et al., 2002).
There is also the question of whether existing opiate treatment programs will be eager to create methadone medical maintenance programs or refer stable patients to office-based services. With current regulations restricting office-based services only to stable patients, clinics may view losing patients who require relatively little attention as having financial implications because they essentially help subsidize the cost of treating more difficult cases (Merrill, 2002).