Initiating Office Based Prescribing of Methadone: Experience of Primary Care Providers in New York City

We report on the experience of 13 primary care providers engaged in office-based prescribing (OBP) of methadone to 50 patients in New York City. The patient group were all women stably enrolled in methadone treatment (mean of 12 years) as part of a randomized trial comparing OBP to usual care in Methadone Maintenance Treatment Programs (MMTP). Practitioners working in hospital clinics and health centers assumed responsibility for the patients' primary care, and wrote orders for their methadone dosage and pick-up schedule. All methadone dispensing, urine testing, and ancillary services were continued through the MMTP. Practitioner attitudes and knowledge about methadone were assessed at the outset and one year later using a structured interview. Providers were easily able to incorporate methadone prescribing into their practice and reported few differences between these patients and other demographically similar patients. They felt that coordination of care was enhanced with this model, and that their skills would improve with an increased OBP caseload of 10-20 patients each. While some problems were noted in dealing with the MMTP clinics in this transitional model of care, at 12 months follow-up we found sustained provider interest in the OBP model and support for combining office-based prescribing with community pharmacy dispensing of methadone.