A NIDA-supported survey of primary care physicians, physician assistants, and nurse practitioners working in New York City found that two-thirds of the clinicians are willing to provide methadone maintenance treatment (MMT) in their offices to opiate addicted patients. Seventy-one clinicians at 11 sites in Manhattan and the Bronx took part in the survey, which was conducted by researchers at the Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, NY. The full report appears this month in the Journal of Urban Health: Bulletin of the New York Academy of Medicine.
"Office based methadone treatment would represent an enormous step forward in treating heroin addiction," said NIDA Director Alan I. Leshner, Ph.D. "This study shows that practitioners understand that their addicted patients are suffering from a treatable disease, and they are willing to provide that treatment."
There are more than 600,000 diagnosed heroin addicts in the U.S. but fewer than 20 percent receive treatment, notes Ernest Drucker, Ph.D., of the Department of Epidemiology and Social Medicine at Montefiore Medical Center, principal author of the report.
"In Europe, Australia, and Canada, more than half of all methadone is prescribed in general practitioner's offices, Dr. Drucker said. "This has dramatically expanded MMT availability and played a key role in containing the AIDS epidemic among injection drug users. In the U.S., however, this treatment is severely restricted by Federal and State laws restricting MMT to large specialized clinics.
In 1996, the Institute of Medicine of the National Academy of Sciences recommended integrating methadone treatment into general medical practice. In 1997, a National Institutes of Health report recommended increased access to MMT, a loosening of Federal and State regulation, and insurance coverage for methadone treatment.
"The principal finding of our study is that these practitioners, who are already caring for the populations and communities most in need of more addiction treatment, are supportive of extending methadone treatment to mainstream medical practice," Dr. Drucker said.
Dr. Drucker and his colleagues interviewed practitioners in community-based primary care and HIV/AIDS clinics serving inner city populations. Most had extensive experience in caring for patients who are on methadone maintenance treatment. Half of the practitioners expressed some concern that the multiple needs of methadone patients would be difficult to meet, but 66 percent said they would prescribe MMT for their patients, given proper training and support.
"For these practitioners, methadone is not laden with stereotypic fears about bringing drug addicts into their practice," Dr. Drucker said. "They see methadone as another useful tool for managing the overall health of their patients."
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432) or 1-888-TTY-NIDA (889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov .
NIDA Contacts: Beverly Jackson or Michelle Muth, 301-443-6245