Methadone medical maintenance (MMM): Treating chronic opioid dependence inprivate medical practice - A summary report (1983-1998)

Methadone Medical Maintenance (MMM) was implemented in 1983 to enable socia lly rehabilitated methadone patients to be treated in the offices of privat e physicians rather than in the traditional clinic system. Over a period of 15 years, 158 methadone patients who fulfilled specific criteria within th e clinic system entered this program in New York City. participating patien ts reported to their physician once a month and received a one-month supply of methadone tablets rather than a one-day liquid dose in a bottle. Of the 158 patients who entered this program, 132 (83.5%) were compliant wi th the regulations and proved to be treatable within the hospital-based pri vate practices of internists participating in the program. Compliant MMM pa tients found it easier to improve their employment status and business situ ations, finish their educations, and normalize their lives in MMM as oppose d to the traditional clinic system because they had simplified reporting sc hedules and fewer clinical restrictions. Twelve (8%) compliant patients wer e able to successfully withdraw from methadone after an average of 17.7 yea rs of treatment in both the traditional clinics and MMM. Twenty compliant p atients (13%) died from a variety of causes, 40% of which were related to c igarette smoking. None of the deaths were attributable to long-term methado ne treatment. Other causes of death included hepatitis C, AIDS, cancer, hom icide, complications of morbid obesity and meningitis. The 26 noncompliant patients (16.5%) were referred back to their clinics fo r continued treatment or were discharged for failure to report as directed. A major cause of failure in MMM was abuse of crack/cocaine. Stigma concerning enrollment in methadone treatment was a major social issu e that patients faced. Many refused to inform employers, members of their f amilies, friends, and other physicians who treated them for a various of co nditions that they were methadone patients. The methadone medical maintenan ce physician, therefore, functions as a medical ombudsman for the patient, educating other physicians who treat the patient about methadone maintenanc e and its applicability to the patient. Our results can serve as a model fo r the expansion of office-based MMM treatment.