Access to narcotic addiction treatment and medical care: prospects for the expansion of methadone maintenance treatment.

Methadone maintenance treatment (MMT) for opioid addiction is safe and effective but underutilized because of inaccessibility, under-financing and the stigma generally attached to maintenance therapies. In addition, cumbersome regulation of methadone prescription and treatment impedes the delivery of care and retards expansion of methadone maintenance into office practice settings. Exaggeration of the problem of methadone diversion further hinders development of MMT. Despite obstacles, methadone maintenance has been successfully expanded and extended into primary care settings abroad. Initial trials in the U.S. have shown that methadone maintenance in physician office-based settings yields positive results with some advantages over care in large methadone clinics. Alternatives to methadone, such as buprenorphine, are also being explored in primary care settings. With implementation of the NIH Consensus Statement on Effective Medical Treatment of Heroin Addiction, including training of primary care physicians, methadone maintenance treatment could reach many more patients, achieve higher success rates, and substantially reduce the deleterious effects of opioid addiction in the U.S.

美沙酮维持治疗（MMT）用于阿片类药物成瘾是安全有效的，但由于难以获取、资金不足以及维持治疗普遍存在的污名化问题，其应用未得到充分利用。此外，美沙酮处方和治疗的繁琐规定阻碍了医疗服务的提供，并延缓了美沙酮维持治疗在门诊环境中的推广。对美沙酮转移问题的夸大进一步阻碍了美沙酮维持治疗的发展。尽管存在障碍，美沙酮维持治疗在国外已成功地扩展并延伸到初级医疗环境中。美国的初步试验表明，在医生办公室环境中进行的美沙酮维持治疗取得了积极的效果，与在大型美沙酮诊所的治疗相比具有一些优势。美沙酮的替代品，如丁丙诺啡，也正在初级医疗环境中进行探索。随着美国国立卫生研究院关于海洛因成瘾有效医疗治疗的共识声明的实施，包括对初级医疗医生的培训，美沙酮维持治疗可以惠及更多患者，提高成功率，并大幅减少阿片类药物成瘾在美国的有害影响。