Synthesizing evidence on the impacts of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for U.S. federal policy

Abstract

As the U.S. faces a worsening overdose crisis, improving access to evidence-based treatment for opioid use disorder (OUD) remains a central policy priority. Federal regulatory changes in response to the COVID-19 pandemic significantly expanded flexibilities on take-home doses for methadone treatment for OUD. These changes have fueled critical questions about the impact of new regulations on OUD outcomes, and the potential health impact of permanently integrating these flexibilities into treatment policy going forward. To aide US policy makers as they consider implementing permanent methadone regulatory changes, we conducted a review synthesizing peer-reviewed research evidence on the impact of the COVID-19 methadone-take-home flexibilities on methadone program operations, OUD patient and provider experiences, and patient health outcomes. We interpret this evidence in the context of the federal rulemaking process and discuss avenues by which these important findings can be incorporated and implemented into U.S. substance use treatment policy going forward.

Methadone’s Resurgence in Bridging the Treatment Gap in the Overdose Crisis: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use, and Addiction)

“…Many of these strategies have already demonstrated efficacy and safety during the COVID-19 public health emergency. [7][8][9][10][11] OTPs can establish community advisory boards of patients with lived and living experience on methadone, including those with ongoing drug use to provide direct (and financially compensated) feedback to clinics on ways to improve patient experience.…”

“…19 Rather, patients and providers reported improved treatment experiences and retention in several early studies. 7-11…”

“…Early evidence suggests these feared consequences of loosened restrictions did not come to fruition, and both patients and clinicians experienced improved quality of care leading to increased treatment retention. [7][8][9][10][11] In light of the escalating overdose crisis, policymakers and researchers are increasingly interested in reexamining and reforming methadone treatment. This layered and shifting landscape of methadone regulation underscores the need for coordination among federal, state, and local entities as well as OTPs themselves to ensure the effectiveness and safety of methadone treatment while addressing the ongoing overdose crisis.…”

“…19 Rather, patients and providers reported improved treatment experiences and retention in several early studies. [7][8][9][10][11] Recognizing the potential benefits of these changes, SAMHSA announced the release of new revised guidelines of 42 CFR Part 8 in January 2024, representing the most significant updates to methadone regulations in over 30 years. 20 The revisions made the COVID-19 take-home exemptions permanent, allowing up to 7 days of takehomes in the first 2 weeks of treatment and up to 28 days after the first month.…”