February 1, 2000
Harborview is first hospital to dispense methadone through pharmacy
A major study on heroin addiction treatment enters an important phase
Feb. 1, as Harborview Medical Center becomes the first health-care facility in the country to dispense methadone through a pharmacy 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 University of Washington (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 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 be treated, according to Merrill.
Seattle and neighboring Vancouver, B.C., have recently had a high number of heroin overdose deaths. Nationally, the number of heroin users is estimated at 800,000 to a million. 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.
The Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation is funding the study.
The UW project follows many treatment and scientific protocols established for methadone treatment, including those from the federal Center for Substance Abuse Treatment (CSAT) and the National Institutes of Health, as well as the Institute of Medicine, the American Society of Addiction Medicine, and the American Methadone Treatment Association. The federal Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) have provided waivers of federal laws that will make it possible for Harborview to dispense methadone as a part of this project. Federal oversight for methadone is being transferred from the FDA to CSAT, which supports methadone treatment in primary-care settings through monitored programs.
“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.
Critics of methadone use argue that addicts substitute their heroin addiction with methadone. Research has demonstrated that methadone does not have any of the harmful behavioral side effects of heroin. Methadone users can also function as useful, productive members of society.
The Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation is a $54 million initiative that funds research into policies affecting alcohol, tobacco and illicit drugs.
