A Qualitative Study of Expanded Methadone Take-Home Access in Opioid Use Disorder Treatment

UC Davis

The United States was already facing a deadly opioid overdose crisis when the COVID-19 pandemic began. Overdose deaths reached 75,000 in the 12 months preceding March 2020, and have continued surging during COVID-19. Buprenorphine and methadone are the two medications for opioid use disorder (MOUD) proven to decrease mortality and increase care retention.

Unlike buprenorphine, which patients can access in office-based settings, methadone for OUD can only be dispensed through licensed opioid treatment programs (OTPs) regulated by federal and state governments. People are required to visit daily, often with one unsupervised “take-home” dose per week when the OTP is closed. Prior to COVID-19, patients could receive privileges for unsupervised take-home doses only after meeting strict guidelines posed by federal and state agencies.

With the onset of the COVID-19 pandemic, public health officials identified the congregate settings of OTPs as high-risk for COVID-19 spread. In March 2020, in efforts to reduce in-clinic crowding without disrupting MOUD access, federal guidance permitted greater access to MOUD, allowing up to 14 days of methadone take-homes for “unstable” patients and 28 days of take-homes for “stable” patients. These regulatory changes to take-home guidelines represent an opportunity to evaluate expanded regulations, especially as similar lower-threshold methadone policies have seen success in other countries.

This paper, “The Idea Is to Help People Achieve Greater Success and Liberty”: A Qualitative Study of Expanded Methadone Take-Home Access in Opioid Use Disorder Treatment, was recently published in the journal Substance Abuse. It describes the MOUD treatment experiences of patients and providers at an OTP in San Francisco to inform future research and policy as the US shifts toward recovery from COVID-19.

CHCF supported both the research and ensuring the publication is available open access.

About the Authors

Leslie Suen, MD, MAS; Stacy Castellanos, MA; Neena Joshi, MS; and Kelly R. Knight, PhD, are all at UCSF. Shannon Satterwhite, MD, PhD, is at UC Davis.