Methadone Treatment Documentation in the Medical Record: Implications for Patient Safety

Most patients receiving methadone maintenance treatment (MMT) also require care for comorbid medical conditions, which typically occurs in separate health-care venues with strict confidentiality rules regulating transfer of medical information. Since clinically important interactions can occur between methadone and some other medications, all treating physicians should know when a patient is receiving methadone. Researchers in this study identified all patients (N=84) in an MMT program who had provided consent for the release of their medical information to an affiliated but separate medical center. The most recent primary care note or hospital discharge summary of each patient was reviewed for mention of opioid use, abuse, or dependence, participation in MMT, and potential interactions between methadone and other drugs

• Medical records lacked documentation of opioid dependence in 30% of patients.

• Medical records lacked documentation of MMT in 11% of patients.

• Sixty-nine percent of patients were prescribed at least 1 medication with the potential to interact with methadone, and 19% were on 3 or more such medications.

Comments:

As the authors point out, transfer of medical information between the MMT program and the medical center in this study was likely a best-case scenario due to the close relationship between the 2 treatment venues and having signed releases in place. Prescription of medications with the potential to interact with methadone is common; however, many medications can be safely prescribed to MMT patients as long as the clinician and patient are aware of and monitoring the potential for interaction. Clinicians can optimize exchange of clinical data between treatment sites by routinely obtaining signed consent from patients for communication between providers, by co-locating MMT with other medical care, and by promoting integrated delivery systems that allow provider access to a single eletronic health record.

Marc N. Gourevitch, MD, MPH

Reference:

Walley AY, Farrar D, Cheng DM, et al. Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue. J Gen Intern Med. 2009;24(9):1007–1011.