Objective:

The authors conducted a scoping review to survey the evidence landscape for studies that assessed outcomes of treating patients with opioid use disorder with methadone in office-based settings.

Methods:

Ovid MEDLINE and the Cochrane Database of Systematic Reviews were searched, and reference lists were reviewed to identify additional studies. Studies were eligible if they focused on methadone treatment in office-based settings conducted in the United States or other highly developed countries and reported outcomes (e.g., retention in care). Randomized trials and controlled observational studies were prioritized; uncontrolled and descriptive studies were included when stronger evidence was unavailable. One investigator abstracted key information, and a second verified data. A scoping review approach broadly surveyed the evidence, and therefore study quality was not rated formally.

Results:

Eighteen studies of patients treated with office-based methadone were identified, including six trials, eight observational studies, and four additional articles discussing use of pharmacies to dispense methadone. Studies on office-based methadone treatment, including primary care-based dispensing, were limited but consistently found that stable methadone patients valued office-based care and remained in care with low rates of drug use; outcomes were similar compared with stable patients in regular care. Office-based methadone treatment was associated with higher treatment satisfaction and quality of life. Limitations included underpowered comparisons and small samples.

Conclusions:

Limited research suggests that office-based methadone treatment and pharmacy dispensing could enhance access to methadone treatment for patients with opioid use disorder without adversely affecting patient outcomes and, potentially, inform modifications to federal regulations. Research should assess the feasibility of office-based care for less stable patients.

中文翻译：

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阿片类药物使用障碍和药房分配的基于办公室的美沙酮治疗：范围审查

客观的：

作者进行了范围审查，以调查评估在办公室环境中使用美沙酮治疗阿片类药物使用障碍患者的结果的研究的证据情况。

方法：

对 Ovid MEDLINE 和 Cochrane 系统评价数据库进行了搜索，并审查了参考文献列表以确定其他研究。如果研究专注于在美国或其他高度发达国家进行的办公室环境中的美沙酮治疗并报告结果（例如，保留在护理中），则这些研究符合条件。优先考虑随机试验和对照观察研究；当没有更强有力的证据时，包括非对照和描述性研究。一位研究人员提取了关键信息，另一位研究人员对数据进行了验证。范围审查方法广泛调查了证据，因此研究质量没有被正式评定。

结果：

确定了 18 项关于以办公室为基础的美沙酮治疗的患者的研究，包括 6 项试验、8 项观察性研究和另外 4 篇讨论使用药房分配美沙酮的文章。对基于办公室的美沙酮治疗（包括基于初级保健的配药）的研究有限，但始终发现稳定的美沙酮患者重视基于办公室的护理并继续接受护理，药物使用率低；与常规护理的稳定患者相比，结果相似。以办公室为基础的美沙酮治疗与更高的治疗满意度和生活质量相关。限制包括动力不足的比较和小样本。

结论：

有限的研究表明，以办公室为基础的美沙酮治疗和药房配药可以增加阿片类药物使用障碍患者获得美沙酮治疗的机会，而不会对患者的预后产生不利影响，并有可能为联邦法规的修改提供信息。研究应评估对病情不稳定的患者进行办公室护理的可行性。