Addiction Science Made Easy
February 2024
CTN Dissemination Library & Northwest ATTC
Every day in the U.S., approximately 1,800 opioid treatment programs (OTPs) treat about 400,000 unique individuals. While this is only a fraction of the estimated 7.6 million people with opioid use disorder (OUD), OTPs have been a mainstay of addiction treatment for decades, operating under highly restrictive guidelines.
When COVID struck the U.S. in March 2020, stay-at-home guidelines limited the ability of patients to seek in-person care. In response, the federal government relaxed some of the restrictions on OTPs, allowing for reduced visit frequency and extended take-home doses for methadone.
Though some research has looked at other models of methadone treatment, no one has looked specifically at the implications of offering extended take-home doses in the first months of care for new OTP patients.
For this study, researchers aimed to fill that gap by examining take-home schedules, adverse events, and clinical outcomes among patients starting methadone treatment at OTP sites under the new, more flexible guidelines.
How Was This Study Conducted?Researchers selected 9 OTPs for the study, geographically dispersed, but all participating in the NIDA Clinical Trials Network. They used electronic health records to pull data on newly enrolled patients in the post-reform (COVID) era, as well as data for a control group from the pre-reform (before COVID) era. They looked at 6-month retention (would having fewer in-person visits make someone more likely to drop out of care?) as well as opioid use and adverse events, including emergency department visits, hospitalizations, and overdose.
Treatment outcomes post-COVID under relaxed regulations were similar to those from the pre-COVID control group, despite slightly higher rates of opioid use in the post-COVID group. This suggests that allowing for 14 and 28 days of take-home methadone early in care may not be associated with increased dropout or adverse events, which is consistent with pre-COVID studies that showed no difference in retention with less frequent in-person dosing.
These findings are meaningful for clinical practice as well as ongoing debate about policy reform as the COVID-19 public health emergency and related rules wind down. More research on this needs to be done to take into consideration other factors that could influence outcomes, like COVID-era disruptions to emergency department and inpatient service use (which could have impacted adverse event reporting, for example, as people who might have otherwise sought care for an adverse event didn’t out of fears of COVID exposure). The fact relaxed guidelines in this study were not associated with measurably increased harms can help inform future studies to confirm the results and improve future care for people taking methadone for opioid use disorder.