Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial

Background and aims: Pharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy. Design: Non-randomized, single-arm, open-label feasibility trial. Setting: One OTP and one community pharmacy in the United States. Participants: One OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take-home methadone doses at 5–160 mg/day. Intervention: Patients’ methadone administration and dispensing of take-home doses was transferred from the OTP to the pharmacy for 3 months. Measurements: Primary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction. Findings: Of 29 patients eligible at pre-screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non-study-related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call-back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study-related adverse events. All participants endorsed ‘pharmacy is the right location for receiving methadone for MMT’, 88% endorsed ‘convenient or very convenient to receive methadone at the pharmacy’ and 88% were satisfied or very satisfied with the quality of treatment offered. Conclusions: This feasibility trial has found pharmacy administration and dispensing of physician-prescribed methadone for methadone maintenance treatment to be feasible and acceptable.