Harborview study tries hospital-based methadone treatment

A major study on heroin addiction treatment entered an important phase Feb. 1, as Harborview Medical Center became the first health-care facility in the country to dispense methadone for patients recovering from heroin addiction.

“This research project examines the impact of a proposed policy change that will expand access to a medical treatment for heroin addiction by providing methadone through primary-care physicians and pharmacies, instead of specialized treatment centers,” says Dr. Joseph Merrill of the UW Department of Medicine and principal investigator of the study.

The study will clarify all the policy issues, physician-training challenges, and patient-safety and acceptability concerns that must be resolved for such programs to be widely replicated, according to Merrill, who practices medicine at Harborview.

“We recognize that heroin addiction is a chronic medical condition that can be effectively treated with medication and counseling,” Merrill says. “Once patients have been stabilized in specialized treatment, the question is whether they can be transferred to the mainstream medical system.”

The Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation is funding the study.

The Harborview study has the potential to open access to methadone treatment for new patients, who often face long waiting lists. If patients who no longer need the intensive services of traditional methadone programs can be moved to a medical setting, other, more needy, patients can then be treated, according to Merrill.

Methadone is used in the treatment of heroin addiction and has been found to be effective in reducing drug use, improving social behavior and personal productivity, and preventing the spread of infectious diseases. Methadone is a highly controlled and regulated substance.

The Harborview program is a pilot project that results from a shift in national policy in the treatment of heroin addiction. Traditionally, all recovering heroin addicts have had to get their methadone from specialized treatment centers through daily visits. The treatment centers are highly regulated through federal, state and local laws. This research project is aimed at identifying conditions under which it would be possible for stable patients to get their methadone from a more convenient location and in multiple take-home doses. It will also show which regulations can be waived to facilitate treatment for heroin addiction.

“Recovering heroin addicts will be selected to participate in this study if they have been in treatment for at least a year and have demonstrated stability in their recovery. These patients have established productive lives without drug abuse, and have already been shown to be responsible in handling multiple take-home methadone doses,” Merrill says.

They will have to undergo monthly as well as random urine testing to check for heroin or other substance abuse and to confirm the use of methadone. Their methadone doses will also be counted to verify appropriate dosing. “But instead of having to go to a treatment facility and get their daily doses of methadone, we will allow them to take a month’s supply of methadone and rely on them to take it on a daily basis,” Merrill says.

Patients selected for this program will also be monitored for alcohol use, criminal activity, or violations involving the sale or transfer of methadone doses to other substance abusers. ¶

Larry Zalin, HMC