Ukrainian Primary Care Clinics Deliver Safer, More Comprehensive Care for Opioid Use Disorder

New research from a large, nationwide trial in Ukraine, finds that primary care clinics that delivered methadone, an opioid use disorder (OUD) treatment, not only achieved comparable outcomes to specialty addiction treatment clinics, but also broadened access to essential preventative and chronic disease services.

The findings—published recently in Annals of Internal Medicine—highlight an avenue for expanding access to care, especially in low- and middle-income countries where shortages of addiction medicine experts are a significant barrier.

Eastern Europe and Central Asia are facing overlapping epidemics of OUD, HIV, and tuberculosis. For the study, a research team led by Frederick Lewis Altice, MD, professor of medicine (infectious diseases) at Yale School of Medicine and of epidemiology (microbial diseases) at Yale School of Public Health, used a telementoring program to continuously support primary care physicians in delivering treatment for these conditions.

The most effective treatments for OUD are opioid agonist therapies including methadone and buprenorphine. The telementoring program not only trained Ukrainian physicians to administer methadone therapy to individuals with OUD, but to also address HIV and tuberculosis.

People living with substance use disorders have significantly shorter lifespans than their counterparts, primarily from untreated non-communicable diseases. Not only did patients at primary care clinics experience similar results to those at specialty clinics with regard to their addiction, but they were also more likely to obtain other recommended services for non-communicable diseases, such as preventative screenings, the researchers found.

Furthermore, the program substantially reduced the stigma of receiving treatment, improved the continuity of HIV and tuberculosis care, and strengthened health system resilience, the researchers say, as shown by additional studies also led by Altice published in the International Journal of Drug Policy and BMC Health Services Research.

“For decades, methadone has been siloed in highly stigmatized specialty clinics that exist outside mainstream medicine,” Altice says. “When we move treatment into primary care, we do not just treat addiction. We restore dignity, rebuild trust, and open doors to lifesaving services that have historically been out of reach.”

In the study, the researchers implemented a telementoring program in 26 primary care clinics across 13 Ukrainian cities. They analyzed the outcomes of adults with OUD receiving methadone through either a primary care clinic or specialty clinic between 2018 and 2024. Nearly 1,500 participants enrolled, making the trial the largest of its kind in any low- or middle-income country.

The study’s structured telementoring program was designed to equip primary care physicians with rapidly expandable expertise. Through one-hour weekly virtual sessions, clinicians received real-time guidance on treating addiction, HIV, tuberculosis, and hepatitis. These sessions created a continuous pipeline of collaborative learning that strengthened clinical capacity, even throughout the COVID-19 pandemic and disruptions caused by Russia’s invasion, the team says.

“Ukraine has long faced a shortage of addiction specialists, and many primary care providers had never managed methadone before this study,” says Kostyantyn Dumchev, MD, senior investigator in Ukraine and a leading addiction and HIV researcher. “The weekly telementoring sessions became a lifeline—a way to learn together, solve real cases, and build confidence. This approach created a community of practice that remained strong even during missile attacks, blackouts, and displacement.”

The study found that patient retention rates were similar, if not better, when patients were treated in primary care than in specialty clinics. Primary care clinicians also achieved guideline-recommended dosing and expanded take-home methadone as their confidence grew. Remarkably, the researchers say, patients remained engaged even during the most intense phases of the war, when many health care systems fractured under strain.

Importantly, patients who received treatment at primary care clinics were also significantly more likely to also receive other recommended services including screening for diabetes, cancer, and other conditions that those with substance use disorders often die from prematurely. Managing these non-communicable diseases are a key to closing the 10- to 25-year gap in premature mortality for patients with substance use disorders who are treated in specialty clinics, the researchers say.

First author Eteri Machavariani, MD, who completed the study as a postdoctoral associate at Yale School of Medicine, emphasized the human impact of shifting care to trusted community settings. “Patients consistently told us that primary care felt safer, more respectful, and more connected to their other health needs,” she says. “That change in environment alone made it easier for them to remain in care.”

These findings offer a powerful blueprint for countries seeking to expand opioid agonist therapies, strengthen chronic disease outcomes, and reduce the stigma that has long undermined addiction treatment.

“At a time when overdose deaths are rising globally and addiction specialty systems are overstretched, the Ukrainian experience demonstrates that brining methadone into primary care is not only feasible—it is transformative,” Altice says.