Context Under new proposed regulations, US physicians outside of traditional
methadone clinics could prescribe methadone to patients with opioid dependence.
No large-scale evaluations of US programs in which methadone maintenance is
provided by primary care physicians are available, but primary care physicians
in Scotland have participated in such programs on a large scale.
Objective To review the history, operation, and outcome data on the efficacy and
safety of 2 Scottish primary care–based opioid agonist treatment programs
to derive lessons for the US context.
Design and Setting Naturalistic study of programs in Edinburgh and Glasgow, Scotland, with
data obtained through site visits and interviews conducted in 1996 and 1998,
as well as from published reports and retrospective analysis of electronic
Main Outcome Measures Proportions of injection drug users who were enrolled in the methadone
maintenance programs, average methadone doses in the programs, and methadone-related
Results A total of 60% to 80% of injection drug users in Edinburgh and 41% to
73% of those in Glasgow were enrolled in methadone maintenance in 1998-1999.
Dose levels are consistent with US recommendations (for Edinburgh in 1998,
61 mg; for Glasgow in 1994-1996, 54 mg). The Glasgow program required supervised
consumption of methadone in community pharmacies for the first year and experienced
significantly fewer methadone-related deaths than Edinburgh in 1997 (17 vs
30 deaths; P<.0001). Programs in both Edinburgh
and Glasgow provided support to primary care physicians and achieved levels
of general practitioner participation of 59% (1998) and 30% (1999), respectively.
Conclusions The Scottish experience indicates that prescription of methadone in
office-based settings can expand access to an important treatment modality.
Primary care physicians safely prescribed methadone for maintenance treatment
when provided with adequate support. Diversion of methadone was minimized
by requiring supervised consumption in community pharmacies.