Increase in Take-Home Methadone Doses Doesn’t Worsen Treatment Outcomes in Study

A near doubling in take-home doses of methadone during an exemption period enacted as a result of the COVID-19 pandemic was not associated with negative treatment outcomes in a recent study conducted in Washington state.

Findings of the study, which tracked 183 patients at a methadone clinic in Spokane County, Washington, were published in the American Journal of Drug and Alcohol Abuse.

To prevent patients from overdosing or diverting medication, those receiving methadone for opioid use disorder are required to visit a federally certified clinic every day for at least 1 year (or longer, depending on their treatment plan). In March 2020, however, the Substance Abuse and Mental Health Services Administration (SAMHSA) created an exemption that allowed opioid treatment programs (OTPs) to provide up to 28 days of take-home doses of methadone to stable clients and up to 14 days of the medication to less-stable clients to reduce in-person interactions in clinics as a result of the COVID-19 pandemic.

Researchers studied a publicly funded OTP in Spokane before and after the onset of the pandemic. The clinic began increasing take-home doses on March 23, 2020. The study looked at English-speaking patients at least 18 years of age who were receiving methadone and had been in treatment and on stable dosing 270 days prior to March 1, 2020, and 270 days after April 1, 2020.

Among the study’s findings:

• Take-home doses increased nearly 200%, with 166 of the 183 patients reporting an increase in take-home doses.
• The number of clients experiencing emergency department visits dropped from 74 in the pre-COVID period to 56 after the SAMHSA take-home exemption was announced.
• Overdose-related ED visits remained nearly identical, dropping from 16 to 15.
• No notable increase in negative screenings for methadone were observed, indicating that patients were maintaining their treatment regimen with their take-home doses.

“Our research highlights the need to consider permanently loosening the restrictions on methadone take-home doses, which would help many people who are struggling to access opioid treatment,” lead study author Ofer Amram, an assistant professor in the WSU Elson S. Floyd College of Medicine, said in a news release announcing the findings.

The researchers did acknowledge limitations in their findings, including access to ED data being limited to the ED hospital in Spokane, the study being limited to stable patients who were already established in long-term treatment, and the potential for increased medication diversion being introduced by upping take-home doses.

While COVID-19-inspired changes in methadone delivery provide a natural opportunity to assess current practices, further research is still needed, the researchers concluded.