Résumé :
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[BDSP. Notice produite par INIST-CNRS q70nR0xE. Diffusion soumise à autorisation]. Context Methadone maintenance is an effective treatment for opioid dependence, yet its use is restricted to federally licensed narcotic treatment programs (NTPs). Office-based care of stabilized methadone maintenance patients is a promising alternative but no data are available from controlled trials regarding this type of program. Objective To determine the feasibility and efficacy of office-based methadone maintenance by primary care physicians vs in an NTP for stable opioid-dependent patients. Design Six-month, randomized controlled open clinical trial conducted February 1999-March 2000. Setting Offices of 6 primary care internists and an NTP. Patients Forty-seven opioid-dependent patients who had been receiving methadone maintenance therapy in an NTP without evidence of illicit drug use for 1 year and without significant untreated psychiatric comorbidity were randomized ; 1 patient refused to participate after treatment assignment to NTP. Interventions Patients were randomly assigned to receive office-based methadone maintenance from primary care physicians, who received specialized training in the care of opioid-dependent patients (n=22), or usual care at an NTP (n=24). Main Outcome Measures Illicit drug use, clinical instability (persistent drug use), patient and clinician satisfaction, functional status, and use of health, legal, and social services, compared between the 2 groups. Results Eleven of 22 (50% ; 95% confidence interval [Cl], 29% - 71%) patients in office-based care compared with 9 of 24 (38% ; 95% Cl, 21% - 57%) of NTP patients had a self-report or urine toxicology test result indicating illicit opiate use (P=39). Hair toxicology testing detected an additional 2 patients in each treatment group with evidence of illicit drug use, but this did not change the overall findings. (...)
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