Article Commentary: Research Priorities for Expanding access to Methadone Treatment for Opioid use Disorder in the United States: A National Institute on Drug Abuse Clinical Trials Network Task Force Report

Abstract

In the US, methadone treatment can only be provided to patients with opioid use disorder (OUD) through federal and state-regulated opioid treatment programs (OTPs). There is a shortage of OTPs, and racial and geographic inequities exist in access to methadone treatment. The National Institute on Drug Abuse Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD. This research agenda included mechanisms that are available within and outside the current regulations. The task force identified 6 areas where research is needed: (1) access to methadone in general medical and other outpatient settings; (2) the impact of methadone treatment setting on patient outcomes; (3) impact of treatment structure on outcomes in patients receiving methadone; (4) comparative effectiveness of different medications to treat OUD; (5) optimal educational and support structure for provision of methadone by medical providers; and (6) benefits and harms of expanded methadone access. In addition to outlining these research priorities, the task force identified important cross-cutting issues, including the impact of patient characteristics, treatment, and treatment system characteristics such as methadone formulation and dose, concurrent behavioral treatment, frequency of dispensing, urine or oral fluid testing, and methods of measuring clinical outcomes. Together, the research priorities and cross-cutting issues represent a compelling research agenda to expand access to methadone in the US.

Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic

“…Collectively, our findings suggest that video observation of methadone take-home dosing may be a viable service model for increasing observation of methadone dosing and potentially increasing take-home dosing privileges for patients who qualify for increased take-home doses but have not demonstrated enough stability to receive the maximum increase in take-home doses allowed by the revised SAMHSA guidelines. The field has a growing interest in testing service delivery models that can expand access to methadone treatment ( Joudrey et al, 2021 ). Other studies have also supported the feasibility and acceptability of video observation of buprenorphine ingestion with and without financial incentives for confirmed buprenorphine adherence ( Godersky et al, 2019 ; Holtyn et al, 2021 ; Tsui et al, 2021 ), electronically controlled pill dispensers for administering and monitoring methadone doses ( Dunn et al, 2021 ; Kidorf et al, 2021 ), and video observed dosing plus electronically controlled pill dispensers for patients receiving methadone or buprenorphine in pill form ( Brooklyn et al, 2021 ).…”

Opioid treatment program prescribing of methadone with community pharmacy dispensing: Pilot study of feasibility and acceptability

“…Study findings provide good support for the feasibility and acceptability of physician prescribing and pharmacy dispensing of methadone for OUD. It is noteworthy that the study was implemented year before a national Task Force was commissioned by NIDA’s Center for Clinical Trials Network (CCTN) to develop a research agenda to increase access to methadone for OUD ( Joudrey et al, 2021 ), which included recommendations for studies evaluating community pharmacy administration of methadone prescribed by OTP physicians and mid-level practitioners.…”

Interim opioid agonist treatment for opioid addiction: a systematic review

“…In a situation of shortage of standard OAT, where treatment demand exceeds availability, interim OAT may be an essential asset to avoid unnecessary delays once the request for OAT is made and the indication is established. Other mechanisms and processes—within and outside current regulatory systems—which could expand and facilitate access and entry of people with opioid use disorder into OAT are also worth considering and studying [ 53 , 54 ].…”