Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial

Abstract

Background and aims: Pharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy.

Design: Non-randomized, single-arm, open-label feasibility trial.

Setting: One OTP and one community pharmacy in the United States.

Participants: One OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take-home methadone doses at 5-160 mg/day.

Intervention: Patients' methadone administration and dispensing of take-home doses was transferred from the OTP to the pharmacy for 3 months.

Measurements: Primary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction.

Findings: Of 29 patients eligible at pre-screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non-study-related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call-back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study-related adverse events. All participants endorsed 'pharmacy is the right location for receiving methadone for MMT', 88% endorsed 'convenient or very convenient to receive methadone at the pharmacy' and 88% were satisfied or very satisfied with the quality of treatment offered.

Conclusions: This feasibility trial has found pharmacy administration and dispensing of physician-prescribed methadone for methadone maintenance treatment to be feasible and acceptable.

Trial registration: ClinicalTrials.gov NCT04308694.

Keywords: Collaborative care; community pharmacy; methadone maintenance treatment; methadone prescribing; opioid treatment program; opioid use disorder.

Conflict of interest statement

Declarations of interest: Robert P. Schwartz has consulted for Verily Life Sciences. He is Principal Investigator of a NIDA-funded study that has received medication at no cost to the study from Alkermes and Indivior. The other authors have no conflicts of interest to disclose.

© 2021 Society for the Study of Addiction.

Figures

Figure 1.

Study diagram

Figure 2.

CONSORT flow diagram

Figure 3.

Treatment retention