Medical maintenance: the treatment of chronic opiate dependence in general medical practice

Abstract

Medical maintenance was created to treat rehabilitated methadone maintenance patients within the context of general medical practice. One hundred methadone patients who met screening criteria were transferred for continuing care from traditional methadone clinics either to the practices of hospital-based physicians or to a health maintenance organization. Patients see their physicians about once per month, submit urine samples at the time of the office visits, drink a dose of methadone in the presence of their doctor or nurse, and receive a 28-day supply of methadone in pill or tablet form. The methadone prescriptions are filled by the hospital pharmacies. Physicians are responsible for the patients' annual physicals and can treat patients for other conditions. In our initial analysis of medical maintenance, 82.5% of the patients remained in good standing and 5% left the program voluntarily in good standing; the remaining 12.5% who were unable to respond favorably were returned to clinic programs. For rehabilitated patients requiring long-term or life-long care, medical maintenance is a viable alternative to traditional clinic programs. With proper policies and procedures, medical maintenance can be implemented in many hospitals.