Methadone Maintenance Patients in General Medical Practice

Abstract

Medical maintenance is the treatment by primary care physicians of rehabilitated methadone maintenance patients who are stable, employed, not abusing drugs, and not in need of supportive services. In this research project, physicians with experience in drug abuse treatment provided both the pharmacologic treatment of addiction as well as therapy for other medical problems, as needed. Decisions regarding treatment were based on the individual needs of the patient and on currently accepted medical practice rather than on explicit regulations. We studied the first 40 former heroin addicts who were transferred to this program from more conventional methadone clinics. At a follow-up visit at 12 to 55 months, 33 (82.5%) of 40 patients had remained in treatment; five (12.5%) had been discharged because of cocaine abuse and two (5%) had been voluntarily discharged. Personal benefits of medical maintenance include the dignity of a standard professional atmosphere and a more flexible reporting schedule. This program has the potential for improving treatment of selected methadone maintenance patients.

Long-Term Pharmacotherapy for Opiate (Primarily Heroin) Addiction: Opioid Agonists

“…Recent studies have shown that there is a dose-dependent increment in favorable patient outcome with the infusion of rehabilitation medical and psychiatric services . Also, studies of medical maintenance (discussed below) have documented that patients who have responded to methadone maintenance treatment with cessation of illicit opiate use, along with cessation of other illicit drug use, and have succeeded in rehabilitation efforts, may no longer need regular counseling services, but clearly benefit, as do all persons, by access to ongoing medical care (NOVICK and JOSEPH 1991;NOVICK et al 1988aNOVICK et al ,b, 1990NOVICK et al , 1994. These findings have suggested that in the future, to assure medically effective as well as socially and cost effective treatment, there will be a need to define both the severity and various types of codependency, comorbidity, and multiple medical problems at time of entry, and to provide on site or ready access to treatment or management for these problems, as well as a need for diverse social services.…”

“…Studies have been conducted in at least three cities and are possibly ongoing in other cities to determine the feasibility and effectiveness of medical maintenance treatment for long-term methadone-maintained patients who have had a good record of treatment performance to be treated in a general clinic or "office based" practice. In the New York City studies, under the leadership of Novick, patients who have had at least 5 years of methadone maintenance treatment in a standard clinic, with excellent performance, that is, with cessation of all illicit opiate use and no ongoing polydrug or alcohol abuse, all positive indicators for rehabilitation, met the inclusion criteria (NOVICK et al 1988a(NOVICK et al ,b, 1990(NOVICK et al , 1994NOVICK and JOSEPH 1991). In this medical maintenance study, patients are seen as infrequently as once every 4 weeks or not more often than once a week, in a medical office (not a drug abuse treatment program) at which time they provide a urine speciment for drug monitoring, take one daily dose of methadone under observation, and undergo a conventional medical, and also intense drug use history, physical examination, and when appropriate, other laboratory testing.…”

Medical Maintenance:

“…Novick et al 1 reported an uncontrolled study in which methadone maintenance patients with the characteristics described above were cared for by physicians in their office with infrequent pick-up for methadone and minimal or no formal counseling. Novick et al described such a paradigm of care as ''Medical Maintenance'' and defined it as ''the treatment by primary care physicians of rehabilitated methadone maintenance patients who are stable, employed, not abusing drugs, and not in need of supportive services.'…”

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

“…Methadone maintenance in physicians’ offices or “medical maintenance” is an alternative format for take-home methadone doses that has the potential of expanding methadone maintenance services for those individuals who are psychosocially stable 66–68. This could potentially include treatment of those with additional chronic pain and can translate in resolving both major limitations to methadone maintenance treatment of comorbid pain and addiction.…”