Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial.

BACKGROUND AND AIMS: Pharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy. DESIGN: Non-randomized, single-arm, open-label feasibility trial. SETTING: One OTP and one community pharmacy in the United States. PARTICIPANTS: One OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take-home methadone doses at 5-160 mg/day. INTERVENTION: Patients' methadone administration and dispensing of take-home doses was transferred from the OTP to the pharmacy for 3 months. MEASUREMENTS: Primary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction. FINDINGS: Of 29 patients eligible at pre-screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non-study-related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call-back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study-related adverse events. All participants endorsed 'pharmacy is the right location for receiving methadone for MMT', 88% endorsed 'convenient or very convenient to receive methadone at the pharmacy' and 88% were satisfied or very satisfied with the quality of treatment offered. CONCLUSIONS: This feasibility trial has found pharmacy administration and dispensing of physician-prescribed methadone for methadone maintenance treatment to be feasible and acceptable.

Research and professional briefs: characterizing process control of fluid viscosities in nursing homes.

Swallowing impairment with advancing age is a major health care problem, especially among nursing home residents. An estimated 40% to 60% of nursing home residents have signs of swallowing disorders or dysphagia. The high number of nursing home residents with dysphagia is, at least in part, caused by patients with swallowing disorders being more likely to be discharged to institutional care. Aging alone does not result in swallowing disorders. Conditions that contribute to swallowing problems include dementia, cerebral vascular accidents, Parkinson's disease, neuromuscular disorders, and some medications. This article discusses the health-related rationale for thickened liquids and fluid viscosities, reviews each phase of the study, and concludes with the practical implications of the study for clinical dietitians.