Journal of General Internal Medicine

, Volume 24, Issue 9, pp 1007–1011 | Cite as

Are Opioid Dependence and Methadone Maintenance Treatment (MMT) Documented in the Medical Record? A Patient Safety Issue

  • Alexander Y. WalleyEmail author
  • Danielle Farrar
  • Debbie M. Cheng
  • Daniel P. Alford
  • Jeffrey H. Samet
Original Article



Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient safety.


To identify potential safety risks among MMT patients engaged in medical care by evaluating the frequency that opioid dependence and MMT documentation are missing in medical records and characterizing potential medication-methadone interactions.


Among patients from a methadone clinic who received primary care from an affiliated, but separate, medical center, we reviewed electronic medical records for documentation of methadone, opioid dependence, and potential drug-methadone interactions. The proportions of medical records without opioid dependence and methadone documentation were estimated and potential medication-methadone interactions were identified.


Among the study subjects (n = 84), opioid dependence documentation was missing from the medical record in 30% (95% CI, 20%–41%) and MMT documentation was missing from either the last primary care note or the last hospital discharge summary in 11% (95% CI, 5%-19%). Sixty-nine percent of the study subjects had at least 1 medication that potentially interacted with methadone; 19% had 3 or more potentially interacting medications.


Among patients receiving MMT and medical care at different sites, documentation of opioid dependence and MMT in the medical record occurs for the majority, but is missing in a substantial number of patients. Most of these patients are prescribed medications that potentially interact with methadone. This study highlights opportunities for improved coordination between medical care and MMT.


methadone medication interactions patient safety care coordination 



The authors would like to thank Eileen Brigandi, Donna Beers, RN, and the staff at Substance Abuse Prevention and Treatment Services, Boston Public Health Commission, for their support and cooperation during this study. We would also like to thank Courtney Pierce for her assistance in manuscript preparation. This project was funded in part by the National Institute on Drug Abuse R25-DA13582. Parts of this work were presented at the Society of General Internal Medicine annual meeting, April 11, 2008; the College on Problems in Drug Dependence annual meeting, June 19, 2008; the Addiction Health Services Research conference, October 21, 2008; and the Association for Medical Education and Research in Substance Abuse annual meeting, November 8, 2008.

Conflict of Interest

None disclosed.


  1. 1.
    Kohn LT, Corrigan JM, Donaldson MS. Committee on quality of health care in america, institute of medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
  2. 2.
    Joint Commission. 2008 National Patient Safety Goals. Available at: Accessed May 31, 2009.
  3. 3.
    Improving the quality of healthcare for mental and substance-use conditions. Institute of Medicine. 504. 2005. Washington, DC: The National Academy Press: 2005.Google Scholar
  4. 4.
    Kleber HD. Methadone maintenance 4 decades later: thousands of lives saved but still controversial. JAMA. 2008;300:2303–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Bureau of National Affairs. Beckerman JZ, Pritts J, Goplerud E, Leifer J, Borzi PC, Rosenbaum S. Health information privacy, patient safety, and health care quality: Issues and challenges in the context of treatment for mental health and substance use.16. Available at: Accessed May 31, 2009.Google Scholar
  6. 6.
    Confidentiality of Alcohol and Drug Abuse Patient Records. Code of Federal Regulations Title 42, Volume 1, Chapter 1, Part 2. Available at: Accessed May 31, 2009.
  7. 7.
    Leshner AI. Science-based views of drug addiction and its treatment. JAMA. 1999;282:1314–16.PubMedCrossRefGoogle Scholar
  8. 8.
    Gourevitch MN, Chatterji P, Deb N, Schoenbaum EE, Turner BJ. On-site medical care in methadone maintenance: associations with health care use and expenditures. J Subst Abuse Treat. 2007;32:143–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Brienza RS, Stein MD, Chen M, et al. Depression among needle exchange program and methadone maintenance clients. J Subst Abuse Treat. 2000;18:331–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Teesson M, Havard A, Fairbairn S, Ross J, Lynskey M, Darke S. Depression among entrants to treatment for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence, correlates and treatment seeking. Drug Alcohol Depend. 2005;78:309–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Milby JB, Sims MK, Khuder S, et al. Psychiatric comorbidity: prevalence in methadone maintenance treatment. Am J Drug Alcohol Abuse. 1996;22:95–107.PubMedCrossRefGoogle Scholar
  12. 12.
    Rosenblum A, Joseph H, Fong C, Kipnis S, Cleland C, Portenoy RK. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. JAMA. 2003;289:2370–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim TW, Alford DP, Malabanan A, Holick MF, Samet JH. Low bone density in patients receiving methadone maintenance treatment. Drug Alcohol Depend. 2006;85:258–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Federman AD, Arnsten JH. Primary care affiliations of adults in a methadone program with onsite care. J Addict Dis. 2007;26:27–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Umbricht-Schneiter A, Ginn DH, Pabst KM, Bigelow GE. Providing medical care to methadone clinic patients: referral vs on-site care. Am J Public Health. 1994;84:207–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Selwyn PA, Budner NS, Wasserman WC, Arno PS. Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. Public Health Rep. 1993;108:492–500.PubMedGoogle Scholar
  17. 17.
    Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann.Intern.Med. 2009;150:387–95.PubMedGoogle Scholar
  18. 18.
    Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Torsade de pointes associated with very-high-dose methadone. Ann Intern Med. 2002;137:501–4.PubMedGoogle Scholar
  19. 19.
    Krantz MJ, Kutinsky IB, Robertson AD, Mehler PS. Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes. Pharmacotherapy. 2003;23:802–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Krantz MJ, Lowery CM, Martell BA, Gourevitch MN, Arnsten JH. Effects of methadone on QT-interval dispersion. Pharmacotherapy. 2005;25:1523–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Martell BA, Arnsten JH, Krantz MJ, Gourevitch MN. Impact of methadone treatment on cardiac repolarization and conduction in opioid users. Am J Cardiol. 2005;95:915–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Leavitt SB. Methadone-drug interactions. Addiction Treatment Forum - 3rd Edition 2005; November 2005: 1–31. Available at: Accessed May 31, 2009.
  23. 23.
    Bruce RD, Altice FL, Gourevitch MN, Friedland GH. Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications: implications and management for clinical practice. J Acquir Immune Defic Syndr. 2006;41:563–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Cance-Katz EF. Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents. Clin Infect Dis. 2005;41(Suppl 1):S89–S95.CrossRefGoogle Scholar
  25. 25.
    Velarde MC, Peino AJ, Gomez de Caso Canto JA. The Methadone Maintenance Program for intravenous heroin addicts. What information do primary care physicians have? Aten Primaria. 1996;17:581–4.Google Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Alexander Y. Walley
    • 1
    • 2
    • 3
    Email author
  • Danielle Farrar
    • 2
  • Debbie M. Cheng
    • 1
    • 4
  • Daniel P. Alford
    • 1
    • 2
  • Jeffrey H. Samet
    • 1
    • 2
    • 3
    • 5
  1. 1.Clinical Addiction Research and Education (CARE) Unit, Section of General Internal MedicineBoston Medical CenterBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.Substance Abuse Prevention and Treatment ServicesBoston Public Health CommissionBostonUSA
  4. 4.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  5. 5.Department of Social and Behavioral SciencesBoston University School of Public HealthBostonUSA

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