COVID-19-related policy changes for methadone take-home dosing: A multistate survey of opioid treatment program leadership

Abstract

Background: In the United States, methadone for treatment of opioid use disorder is dispensed via highly-regulated accredited opioid treatment programs (OTP). During the COVID-19 pandemic, federal regulations were loosened, allowing for greater use of take-home methadone doses. We sought to understand how OTP leaders responded to these policy changes. Methods: We distributed a multistate electronic survey from September to November 2020 of OTP leadership to members of the American Association for the Treatment of Opioid Dependence (AATOD) who self-identified as leaders of OTPs. We asked study participants about how their OTP(s) implemented COVID-19-related policy changes into their clinical practice focusing on provision of take-home methadone doses, factors used to determine patient stability, and potential concerns about increased take-home doses. We used Chi-square test to compare survey responses between characterizations of the OTPs. Results: Of 170 survey respondents (17% response rate), the majority represented leadership of for-profit OTPs (69%) and were in a Southern state (54%). Routine allowances and practices related to take-home methadone doses varied across OTPs during the COVID-19 pandemic: 80 (47%) reported 14 days for newly enrolled patients (within past 90 days), 89 (52%) reported 14 days for “less stable” patients, and 112 (66%) reported 28 days for “stable” patients. Conclusions: We found that not all eligible OTP leaders adopted the practice of routinely allowing newly enrolled, “less stable,” and “stable” patients on methadone to have increased take-home doses up to the limit allowed by federal regulations during COVID-19. The pandemic provides an opportunity to critically re-evaluate long-established methadone and OTP regulations in preparation for future emergencies.

Keywords:

• Methadone
• opioid-related disorders
• COVID-19
• survey
• opioid treatment programs

Acknowledgments

We wish to thank Mark Parrino, President of the American Association for the Treatment of Opioid Dependence for facilitating survey distribution. We would like to acknowledge Research in Addiction Medicine Scholars (RAMS) program fellows and the faculty and fellows of the Division of General Internal Medicine at Oregon Health & Science University School of Medicine and Johns Hopkins University School of Medicine for their feedback on the survey development. Figure 1 created with BioRender.com. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclosure statement

KBS serves on the Boards of Directors of the American Association for the Treatment of Opioid Dependence, and the Maryland Association for the Treatment of Opioid Dependence. He also serves on the Center for Substance Abuse Treatment National Advisory Council of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration. The other authors – XAL, JDP, PTK, and GC – declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. No potential conflict of interest was reported by the author(s).

Author contributions

XAL & JDP were equally responsible for study conceptualization, survey design, data collection, interpretation of results and manuscript development, and revision. JDP was responsible for data analysis. KS contributed to the data collection, interpretation of results, and manuscript revision. PTK contributed to the development and manuscript revision. GC contributed to the study development, interpretation of results, and manuscript revision. All authors approved of the final version to be published.

Additional information

Funding

XAL was supported by the Samuel H. Wise General Internal Medicine Fellowship and the Research in Addiction Medicine Scholars Program [R25DA033211]. JDP was supported by the Research in Addiction Medicine Scholars Program [R25DA033211] and the National Heart, Lung, and Blood Institute [T32 HP10025]. PTK was supported by the National Institutes of Health awards UH3DA044831 and UG1DA015815. GC was supported by the National Institute on Alcohol Abuse and Alcoholism [K24 AA027483].