Access to narcotic addiction treatment and medical care: Prospects for theexpansion of methadone maintenance treatment

Methadone maintenance treatment (MMT) for opioid addiction is safe and effe ctive but underutilized because of inaccessibility, under-financing and the stigma generally attached to maintenance therapies. In addition, cumbersom e regulation of methadone prescription and treatment impedes the delivery o f care and retards expansion of methadone maintenance into office practice settings. Exaggeration of the problem of methadone diversion further hinder s development of MMT. Despite obstacles, methadone maintenance has been successfully expanded and er;tended into primary care settings abroad. Initial trials in the U.S, ha ve shown that methadone maintenance in physician office-based settings yiel ds positive results with some advantages over care in large methadone clini cs. Alternatives to methadone, such as buprenorphine, are also being explor ed in primary care settings. With implementation of the NIH Consensus State ment on Effective Medical Treatment of Heroin Addiction, including training of primary carl physicians, methadone maintenance treatment could reach ma ny more patients, achieve higher success rates, and substantially reduce th e deleterious effects of opioid addiction in the U.S.