Integrating Methadone Into Primary Care: Lessons From Ukraine

Opioid use disorder (OUD) is a global challenge, affecting more than 16 million persons worldwide and contributing to substantial morbidity and mortality from overdose, acute and chronic infections, and other causes (1).Although burden is greatest in high-income nations, low-and middle-income countries (LMICs) experience consequential impact.Opioid agonist medications, like methadone and buprenorphine, reduce all-cause and overdose mortality, improve treatment retention, reduce transmission of HIV and hepatitis C virus, and improve quality of life (2).Despite strong evidence, there is a large implementation gap in both high-income and LMIC settings.Key to addressing this gap is extending the reach of opioid agonist treatment (OAT).Although health policy and delivery contexts vary globally, integrating OAT into primary care offers a promising approach.Primary care settings have a large workforce, can address comorbid chronic conditions, and may reduce stigma associated with seeking treatment.However, there are well-documented barriers to implementation, including limited provider knowledge, negative attitudes toward OAT, competing priorities, and limited support services and care coordination (3).In their article, Machavariani and colleagues report findings from a trial in Ukraine comparing methadone treatment integration in primary care with usual care and examining its effect on the delivery of guideline-concordant preventive and treatment services (4).Ukraine is a middle-income country with a high prevalence of HIV and hepatitis C virus concentrated among persons with OUD who inject drugs.Although both buprenorphine and methadone are available in Ukraine, methadone is more widespread.In this study,