Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies.

Abstract

Opioid-use disorder has been declared a public health crisis across North America. One of the most common treatments for opioid-use disorder is opioid agonist therapy, including MMT. This study examined the impact of methadone dispensing in clinic (onsite) pharmacies versus community (offsite) pharmacies on treatment retention for patients initiating MMT. We conducted a cohort study of 3743 patients who initiated MMT between 2011 and 2012 across a network of 43 MMT clinics in Ontario, Canada. Patients were grouped by level of collaboration between the clinic and the pharmacy that they most frequented over the course of their treatment window. The primary outcome was continuous retention in treatment as measured by opioid agonist dosing records between patients with clinic (onsite) pharmacy dosing versus community (offsite) pharmacy dosing. Of the 3743 patients identified, those who filled their methadone prescriptions at onsite pharmacies were 77.0% less likely to withdraw from treatment before one year (n = 2605; aHR = 0.230; CI_95% = (0.210, 0.253); p < 0.001) when compared to the community (offsite) pharmacy group (n = 1138). Moreover, patients using a clinic (onsite) pharmacy demonstrated a one-year retention of 57.3% compared to 11.9% retention of the community (offsite) pharmacy group. The results of this study suggest that clinic (onsite) pharmacy methadone dosing results in a greater likelihood of retention in MMT compared to community (offsite) pharmacy dosing. The study highlights the importance of coordinating delivery of care across patient, physician, and pharmacist in delivery of treatment services.