Li-Tzy Wu1,2,3,4, William S John1, Eric D Morse5, Steve Adkins6, Jennifer Pippin6, Robert K Brooner7, Robert P Schwartz8. 1. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA. 2. Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. 3. Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA. 4. Duke Institute For Brain Sciences, Duke University, Durham, NC, USA. 5. Morse Clinics, Raleigh, NC, USA. 6. Health Park Pharmacy, Raleigh, NC, USA. 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA. 8. Friends Research Institute, Inc, Baltimore, MD, USA.
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.
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.
Authors: Paul J Joudrey; Nicholas Chadi; Payel Roy; Kenneth L Morford; Paxton Bach; Simeon Kimmel; Emily A Wang; Susan L Calcaterra Journal: Drug Alcohol Depend Date: 2020-03-27 Impact factor: 4.492
Authors: Li-Tzy Wu; William S John; Udi E Ghitza; Aimee Wahle; Abigail G Matthews; Mitra Lewis; Brett Hart; Zach Hubbard; Lynn A Bowlby; Lawrence H Greenblatt; Paolo Mannelli Journal: Addiction Date: 2021-01-11 Impact factor: 7.256
Authors: Paul J Joudrey; Gavin Bart; Robert K Brooner; Lawrence Brown; Julie Dickson-Gomez; Adam Gordon; Sarah S Kawasaki; Jane M Liebschutz; Edward Nunes; Dennis McCarty; Robert P Schwartz; José Szapocnik; Madhukar Trivedi; Judith I Tsui; Arthur Williams; Li-Tzy Wu; David A Fiellin Journal: Subst Abus Date: 2021 Impact factor: 3.716