Take-home dosing experiences among persons receiving methadone maintenance treatment during COVID-19

Abstract

Purpose Methadone maintenance treatment is a life-saving treatment for people with opioid use disorders (OUD). The coronavirus pandemic (COVID-19) has introduced many concerns surrounding access to opioid treatment. In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance allowing for the expansion of take-home methadone doses. We sought to describe changes to treatment experiences from the perspective of persons receiving methadone at outpatient treatment facilities for OUD. Methods We conducted an in-person survey among 104 persons receiving methadone from three clinics in central North Carolina in June and July 2020. Surveys collected information on demographic characteristics, methadone treatment history, and experiences with take-home methadone doses in the context of COVID-19 (i.e., before and since March 2020). Results Before COVID-19, the clinic-level percent of participants receiving any amount of days' supply of take-home doses at each clinic ranged from 56% to 82%, while it ranged from 78% to 100% since COVID-19. The clinic-level percent of participants receiving a take-homes days' supply of a week or longer (i.e., ≥6 days) since COVID-19 ranged from 11% to 56%. Among 87 participants who received take-homes since COVID-19, only four reported selling their take-home doses. Conclusions Our study found variation in experiences of take-home dosing by clinic and little diversion of take-home doses. While SAMSHA guidance should allow expanded access to take-home doses, adoption of these guidelines may vary at the clinic level. The adoption of these policies should be explored further, particularly in the context of benefits to patients seeking OUD treatment.

The Impact of the COVID-19 Pandemic on Opioid-Related Harm in Ontario

“…29 These measures improved OAT continuity and, despite initial concerns of sharing or improper dosing of OAT medications, there is no evidence that they increased the risk of harm to patients or communities. 30 Use a harm reduction approach to OAT by relaxing entry and management criteria. 15 Continue providing telemedicine-based OAT appointments, where possible (see additional considerations on telemedicine-based addiction treatment, below).…”

Changes in methadone take-home dosing before and after COVID-19

“…Regulatory bodies were concerned with increase diversion as a result of increases in take home methadone doses. However, to date little evidence exists that increased diversion of take-home methadone occurred after take-home guidelines loosened (Figgatt et al, 2021;Trujols et al, 2020). In addition, patient satisfaction with methadone treatment programs has improved after the new SAMHSA guidelines (Patton et al, 2021).…”

“…A methadone clinic in Wuhan, China, observed a reduction in daily methadone administration while the number of new patients initiating methadone was unchanged at an OTP in Seattle, Washington, before and after COVID-19 community transmission (Jiang et al, 2020;Peavy et al, 2020). Other studies in both the United States and Spain that also examined the impact of an increase in take-home medication as a result of COVID-19 showed that rare or undetectable level diversion of take-home methadone has been occurring after take-home guidelines were loosened (Figgatt et al, 2021;Trujols et al, 2020). Furthermore, patient satisfaction with methadone treatment programs has improved after the new SAMHSA guidelines (Patton et al, 2021).…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…Other mitigation measures that were introduced during periods when social restrictions were in place were increasing dispensing of take-home medications such as methadone. In the results section we noted that two of the included studies examined increases in the provision of take-home medication (OAT) during the initial stages of the pandemic and found there to be few negative consequences associated with this in terms of diversion of medication [52][53][54]. These are interesting findings as the issue of non-supervised consumption of OAT is a contested topic and especially relating to concerns over the diversion of medication and potential increased risk of overdose [78].…”

“…The largest group of studies focused on treatment/recovery services (Table 5). Six of the eight studies sought the views of PWUD regarding the impact of the COVID-19 pandemic [36,37,42,53,54,61]. There is good quality evidence that the pandemic has had serious impacts on thoughts, feelings and behaviours such as stress, anger and feelings of isolation.…”