Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis

Nguyen, Oanh Kieu; Steiger, Scott; Snyder, Hannah; Perrotta, Matthew; Suen, Leslie W.; Joshi, Neena; Castellanos, Stacy; Shapiro, Brad; Makam, Anil N.; Knight, Kelly R.

doi:10.1101/2021.12.10.21267477

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Trietler et al’s study among a small group of New Jersey MOUD providers reported a shift towards telehealth, a reduction in toxicology screening and counseling services, and modifications to multi-day dosing [ 38 ]. A study of a San Francisco methadone treatment program reported full implementation of federal regulations (largely undefined) with outcomes demonstrating the benefit of increased take-home doses on hospitalizations and emergency department visits [ 39 ]. The closest alignment of provider reporting and patient experience is a multi-state study by Krawczyk of unpublished data reported to HHS Office of The Inspector General from methadone clinics.…”

Section: Discussionmentioning

confidence: 99%

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Meyerson

Bentele²,

Russell³

et al. 2022

PLoS ONE

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Objective To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. Methods This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. Results Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. Conclusions MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

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Section: Discussionmentioning

confidence: 99%

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Meyerson

Bentele²,

Russell³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

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Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19

Meyerson,

Bentele,

Brady

et al. 2024

AJPM Focus

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The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review

Adams,

Blawatt,

Magel

et al. 2023

Subst Abuse Treat Prev Policy

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Background The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. Methods The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.–Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. Results Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients’ exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. Conclusion The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.

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Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis

Cited by 3 publications

References 14 publications

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19

The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review

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