In a policy document on “Methadone Reform” updated this spring by the American Association for the Treatment of Opioid Dependence (AATOD), the organization has clearly noted that dosing in the clinic is associated with improved treatment retention, and that pharmacy distribution has been linked to diversion and to concomitant getting rid of methadone as a treatment altogether.
- Based on reports from Scotland about diversion of methadone in pharmacy distribution, several parliaments in that country have considered ending access to methadone treatment entirely, AATOD noted. This particular challenge abroad motivated the World Federation for the Treatment of Opioid Dependence to write a letter to the Scottish Parliament and members of the Irish Parliament to forestall such legislative considerations, according to AATOD.
- In addition, in research published in 2018 looking at the difference between clinic-dosing and pharmacy dosing in Canada, for which patients used in-clinic pharmacies, those in-clinic pharmacies were shown to have much better retention (see https://atforum.com/2019/01/pharmacy-provides-convenience-minimizes-stigma-enhancing-retention/ ). “The findings of this study suggest that patients receiving methadone dosing within the MMT clinic have an increased likelihood of being retained in care as compared to patients choosing to obtain observed dosing in a community pharmacy. We advocate that both the physician and patient should be aware that in-clinic methadone dosing correlate with improved treatment retention,” the authors concluded.
For these two reasons, AATOD does not, at this time, recommend the use of pharmacies dispensing methadone through physician prescribing. However, AATOD does think that medical directors of opioid treatment programs (OTPs, or methadone clinics) should have the option to have stable patients, as defined by the Substance Abuse and Mental Health Services Administration, to receive their medication through pharmacies, if both the OTP and patient desire this.
“To be clear, this would involve methadone-maintained patients, who are currently enrolled in OTPs,” AATOD states. “We also recommend that an agreement be developed between an OTP and a pharmacy to ensure electronic communication of prescriptions that cannot be duplicated or altered in any way and can require two-way communication such that the pharmacy is able to report to the OTP any problems with the dispensing of medication.
Gauthier G, Eibl JK, Marsh DC: Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies. Drug Alcohol Depend. 2018 Oct 1;191:1-5.
doi: 10.1016/j.drugalcdep.2018.04.029. Epub 2018 May 31.