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Methadone Maintenance in Primary Care

Principal Investigator: Joseph Merrill, M.D., M.P.H. , Clinical Assistant Professor of Medicine
Publications Type: Journal Article
Author(s): Merrill J.O., Jackson R.
Article Title: Treatment of heroin dependence
Journal: Annals of Internal Medicine
Volume/Issue/Pages: 134, 2: 165-6
Year: 2001
Abstract:
In their excellent review of pharmacologic treatment of heroin dependence, O’Connor and Fiellin (1) highlight the progress being made toward reintegrating addiction treatment into medical care settings. The separation of the addiction treatment system from mainstream medicine has limited physician knowledge about addictions and has isolated and stigmatized the system itself. One response to this separation is "medical maintenance," the treatment of stabilized methadone recipients in physician office-based practices. The authors assert that such programs will require regulatory changes to become feasible, yet recent progress has been made toward moving such programs into the mainstream. Previously, all medical maintenance programs were approved as experimental programs using the U.S. Food and Drug Administration (FDA) investigational new drug (IND) mechanism. In contrast, our new medical maintenance program in Seattle, Washington, has been granted program-wide exemptions from key FDA regulations, making medical maintenance possible without the IND mechanism. A recent letter from the leaders of the FDA and the Center for Substance Abuse Treatment, citing the Seattle program and a similar program in Connecticut, has made it clear that applications for such program-wide exemptions will be favorably considered. Given this federal leadership, and the precedent set by these new programs, medical maintenance is moving beyond the experimental phase and toward becoming an integral part of the continuum of care for heroin-dependent patients. It is now up to methadone treatment programs, physicians, and state methadone authorities to replicate these programs, allowing patients more flexibility in their care and increasing access to treatment. The generalist physicians in our program have found their practices to be enhanced as a result of their participation. Encountering patients who are addressing such a powerful addiction is humbling and inspiring, and having effective pharmacologic tools to assist these patients is highly rewarding.
Publications Type: Journal Article
Author(s): Merrill J.O.
Article Title: Policy progress for physician treatment of opiate addiction.
Journal: Journal of General Internal Medicine
Volume/Issue/Pages: 17, 5: 361-8
Year: 2002
Abstract:
Medical treatment of heroin addiction with methadone and other pharmacotherapies has important benefits for individuals and society. However, regulatory policies have separated this treatment from the medical care system, limiting access to care and contributing to the social stigma of even effective addiction pharmacotherapy. Increasing problems caused by heroin addiction have added urgency to the search for policies and programs that improve the access to and quality of opiate addiction treatment. Recent initiatives aiming to reintegrate methadone maintenance and other addiction pharmacotherapies into medical practice may promote both expanded treatment capacity and increased physician expertise in addiction medicine. These initiatives include changes in federal oversight of the opiate addiction treatment system, the approval of physician office–based methadone maintenance programs for stabilized patients, and federal legislation that could enable physicians to treat opiate addiction with new medications in regular medical practice.
Publications Type: Journal Article
Author(s): Merrill J.O.
Article Title: Integrating medical care in addiction treatment
Journal: Journal of General Internal Medicine
Volume/Issue/Pages: 18, 1: 68-69
Year: 2003
Abstract:
No abstract available.

 
   
 
 
     
   
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