Treatment Outcomes in a Specialized Opioid Maintenance Program for Prescription Opioid Use Disorder in Israel

Background: A rapid increase in opioid prescriptions necessitated the implementation of a specific opioid maintenance treatment arm in the Methadone Maintenance Treatment clinic for opioid use disorder (OUD). Objective: To characterize patients referred to this arm, those who initiated treatment and their outcomes. Methods: Individuals referred between November/2019 and June/2025 were included. Patient characteristics, retention, and drug abstinence were studied. Results: Of 184 referrals, 54 (29.3%) were admitted. They had a higher female proportion (50% vs. 32.3%, p=0.03) and more years of education (13.1± 3.4 vs. 11.2± 3.8, p=0.008) than those not admitted, with no significant age difference (50.5± 15.8 vs. 52.0± 16.4, p=0.6). Of the 54 admitted patients, 5 were transferred to the “regular” OUD arm. Of the remaining 49, 18.4% were treated with methadone and 40 with oral buprenorphine (21 switched later to a once-monthly injectable formulation). Overall, 42.9% used fentanyl: 44.4% of those on methadone, 42.1% on buprenorphine, and 42.9% on the injectable formulation. Ninety (51.4%) stayed one year; of them, 88.9% stopped prescription opioids. Cumulative retention was longer among females (2.3y, 95% CI: 1.8– 2.9) than males (1.2y, 95% CI: 0.8– 1.6, p=0.046). Retention among those treated with injectable buprenorphine (2.4y, 95% CI: 1.8– 3.0) or methadone (1.7y, 95% CI: 0.9– 2.4) was comparable, and both were longer than with oral buprenorphine (0.7y, 95% CI: 0.4– 1.0, p< 0.001 and p=0.039, respectively). Conclusion: Positive treatment outcomes were observed in this specific population, particularly among those treated with methadone or injectable buprenorphine, but future follow-up and a larger sample are needed. Physicians’ education is necessary to achieve more accurate referrals.