What The Future Holds

Methadone maintenance has demonstrated its effectiveness in reducing illicit drug use and facilitating the transition to a productive lifestyle. In the mid to late 1990s, two major scientific bodies reviewed the evidence on methadone maintenance and concluded it was an effective modality whose usefulness was greatly reduced by stigma and over regulation (National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998; Rettig & Yarmolinsky, 1995). The documents produced by these groups have been instrumental in efforts around the country to reduce barriers and make the delivery system more flexible and responsive to patient needs.

Research including long-term followup indicates that stabilized and socially responsible methadone patients can be safely given a month of take-home medication by physicians in an office-based practice (Novick & Joseph, 1991; Novick et al., 1994). The federal government is in the process of formulating guidelines and regulations to permit treatment to occur in the office of a physician affiliated with a methadone clinic. For the patient, this represents a significant opportunity to shift from the traditional treatment system, segregated from the rest of medical practice since the 1960s, to the mainstream medical system. Although these changes are likely to be implemented most easily with stabilized methadone patients, pilot programs are underway to admit new patients (such as those in rural areas) to an office-based practice. Concurrently, the development of an accreditation mechanism is intended to simplify regulations and emphasize clinical practice guidelines that are more easily modified in response to emerging research findings. These activities will likely reduce barriers to treatment and allow for the development of less restrictive treatment settings.

Other maintenance pharmacotherapies, particularly LAAM and buprenorphine, have been developed and will broaden the options and possibilities for effective intervention. Federally sponsored training efforts have improved the quality of care and will continue to be essential to disseminating current information and providing opportunities for skill development. Slowly, patients have emerged as visible examples of success and to serve as role models for others. Barriers to participation in residential treatment are beginning to be removed. It is hoped that developments will engender future gains and allow this modality to gain the acceptance it so greatly deserves.


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