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.

Autor: Hoffman KA; Oregon Health and Science University-Portland State University, School of Public Health, Portland, OR, United States of America. Electronic address: hoffmaki@ohsu.edu., Foot C; Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, United States of America., Levander XA; Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, United States of America., Cook R; Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, United States of America., Terashima JP; Yale University, New Haven, CT, United States of America., McIlveen JW; Oregon Health Authority, State Opioid Treatment Authority, Salem, OR, United States of America., Korthuis PT; Oregon Health and Science University-Portland State University, School of Public Health, Portland, OR, United States of America; Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, United States of America., McCarty D; Oregon Health and Science University-Portland State University, School of Public Health, Portland, OR, United States of America; Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, United States of America.
Jazyk: angličtina
Zdroj: Journal of substance abuse treatment [J Subst Abuse Treat] 2022 Oct; Vol. 141, pp. 108801. Date of Electronic Publication: 2022 May 08.
DOI: 10.1016/j.jsat.2022.108801
Abstrakt: Objectives: In March 2020, the Substance Abuse and Mental Health Services Administration permitted Opioid Treatment Programs (OTPs) to relax restrictions on take-home methadone and promoted telehealth to minimize potential exposures to COVID-19. We assessed the effects of COVID-19-related changes on take-home methadone dosing in two OTPs serving five rural Oregon counties.
Methods: We used a mixed-methods convergent design. The OTPs extracted urine drug test (UDT) results, take-home methadone regimens, and treatment retention from the electronic health record (EHR) for patients (n = 377). A mixed-effects negative binomial regression model assessed patient-level differences in take-home doses before and after the COVID-19 policy changes and the associations with treatment discontinuation, and UDT positivity. Semi-structured qualitative interviews (n = 32) explored patient reactions to increased take-home dosing and reduced clinic visits to provide context for quantitative findings.
Results: The number of take-home doses increased in the post-COVID-19 period for patients engaged in treatment for more than 180 days (median: 8 vs 13 take-home doses per month, p = 0.011). Take-homes did not increase for patients with fewer days of treatment. Each percentage point increase in take-home dosing above what would be expected without COVID-19 policy changes was negatively associated with the percent of UDT positive for opioids (B = -0.12, CI [-0.21, -0.04], p = 0.005) and the probability of treatment discontinuation (aOR = 0.97, CI [0.95, 0.99], p = 0.003). Qualitative analysis revealed three themes explaining how increased take-home dosing supported recovery: 1) value of feeling trusted with increased responsibility; 2) reduced travel time permitted increased employment and recreation; and 3) reduced exposure to individuals less stable in recovery and potential triggers.
Conclusions: Take-home methadone dose relaxations were associated with increased methadone take-home doses, improved retention, and decreased UDT opioid positive results among clinically stable patients. Qualitative findings suggest that fewer take-home restrictions are feasible and desirable and do not pose safety or public health harms.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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