Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural opioid treatment programs: A mixed methods analysis

Hoffman, Kim; Foot, Canyon; Levander, Ximena A.; Cook, Ryan; Terashima, Javier Ponce; McIlveen, John W.; Korthuis, P Todd; McCarty, Dennis

doi:10.1016/j.jsat.2022.108801

Cited by 39 publications

(37 citation statements)

References 22 publications

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“…34 Some research has found that implementation of extended take-home durations was associated with longer retention in MT. 35…”

Section: Discussionmentioning

confidence: 99%

“…During the pandemic, the federal government changed its policies to allow extended take‐home doses of methadone 34 . Some research has found that implementation of extended take‐home durations was associated with longer retention in MT 35 . It is possible that extended take‐home durations also resulted in changes to reasons for discharge.…”

Section: Discussionmentioning

confidence: 99%

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Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

2022

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Background and Objectives Methadone treatment (MT) for opioid use disorder is only available in opioid treatment programs (OTPs) in the United States, with retention predictive of positive health outcomes. OTP discharge reason information is needed to develop interventions for facilitating MT retention. We sought to identify discharge reason frequencies and associations between discharge reasons and facility/county‐level characteristics. Methods We examined annual OTP discharge reasons for all Florida OTPs from 2014 to 2017 (n = 44,774 discharges). We used multinomial logistic regression analysis to examine associations between patients’ discharge reasons and (1) facility‐level characteristics (e.g., size, funding type) and (2) county‐level characteristics (e.g., race/ethnicity, overdose rates). Results Lost contact was the most common discharge reason (29%). Only 11% of patients were discharged for treatment completion, with the proportion one‐third as low in privately versus publicly‐funded OTPs (p < .001). Privately‐funded OTPs had a patient share self‐terminating treatment against medical advice about 3.5 times higher than publicly‐funded OTPs. Inability to pay accounted for 7% of OTP discharges. Noncompliant discharges represented 6% and were more common in counties with larger proportions of Black residents (p < .01). Counties with higher drug overdose rates had significantly more discharges for noncompliance or self‐terminating against medical advice (p < .01 and p < .05). Discussion and Conclusions Statewide differences in discharge reasons exist between publicly and privately‐funded OTPs, possibly reflecting differences in funding incentives and state oversight. State agencies should develop consistent approaches for collecting/reporting discharge reasons. Scientific Significance Our study is the first to examine the relationship between OTP funding type and discharge reasons.

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“…34 Some research has found that implementation of extended take-home durations was associated with longer retention in MT. 35…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

2022

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“…The review sheds light on the following potential benefits of long-term flexibility for take-home doses: First, many patients described that receiving increased take-homes and being given the responsibility to manage their medication resulted in feelings of pride, accomplishment and selfconfidence that supported treatment goals and sobriety, and helped build a stronger relationship with their providers (Suen, 2022;Hoffman, 2022;Krawczyk, 2021). 37,32,38,39 Patients described additional take-homes as liberating (Harris, 2021) 40 and valued how increased take-homes, and reduced OTP visits, provided them with a sense of normalcy and stability (Levander, 2021) 38 and reduced stigma associated with frequent clinic attendance (Walters, 2022). 41 Patients also reported that reduced travel to the clinic gave them more time to attend to aspects of their lives such as jobs, school, caregiving, and recreation (Suen, 2022; Hoffman,2022; Walters, 2022; Nobles, 2021).…”

Section: Potential Benefits Of the Proposed Rulementioning

confidence: 99%

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

Krawczyk¹,

Rivera²,

Levin

et al. 2022

Preprint

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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.

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“…Even less is known regarding impacts on other front-line treatments, such as methadone, naltrexone, therapy/counseling, and research to date concerns non-Veterans (e.g., Zhang et al, 2022 ; Will et al, 2022 ; Morgan et al, 2022 ; Hoffman et al, 2022 ; Gomes et al, 2022 ; Joudrey et al, 2021 ). Each treatment was likely impacted differently during the pandemic, as the MOUD policy exemptions did not relate to naltrexone prescriptions and they differentially targeted access to methadone, buprenorphine, and therapy/counseling via telehealth.…”

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study

Livingston¹,

Davenport²,

Head³

et al. 2022

Drug and Alcohol Dependence

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Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural opioid treatment programs: A mixed methods analysis

Cited by 39 publications

References 22 publications

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

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

The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study

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