Office-based Opioid Treatment (OBOT)

Abstract

Objective: This article is the second in a series on office-based methadone treatment in primary care settings in conjunction with community pharmacists and social work. This article describes a multi-site study of office-based treatment of stable methadone maintenance (MM) patients utilizing a team consisting of primary medical care practitioners as prescribers, community pharmacies as methadone dispensing sites, and psychosocial treatment and case management through a social worker. Prior to beginning the clinical trial in New Mexico, we surveyed the clinical team as to knowledge, attitudes, and expectations about MM. Methods: A self-administered 34-item survey of each practitioner's knowledge, attitudes, and expectations about MM was completed prior to a 4-session methadone-training program. Eighteen medical providers, 9 community pharmacists, and 1 social worker who had agreed to participate in the pilot study completed the survey. Results: Sixty-one percent of the medical providers, 66% of the community pharmacists, and the social worker were convinced of methadone's effectiveness, supporting methadone “treatment on demand.” The majority of the providers surveyed (72% of the medical providers, 77% of the pharmacists, and the social worker) strongly support MMT for all heroin users who want methadone. However, specific attitudes about the goals and length of methadone treatment vary substantially among this group. Two thirds of the medical providers, 1 pharmacist, and the social worker thought abstinence from all opioids, including methadone, should be the principal goal of treatment. Conclusions: The findings from this study indicate that the clinical team has a good general understanding of MMT and supports its wider use though OBOT in New Mexico. Some of their attitudes and beliefs underscore the need for further education and ongoing supervision in OBOT.