Treatment provider perceptions of take-home methadone regulation before and during COVID-19

Erin Fanning Madden; Bryson T Christian; Pooja A Lagisetty; Bradley R Ray; Sandra H Sulzer

doi:10.1016/j.drugalcdep.2021.109100

Treatment provider perceptions of take-home methadone regulation before and during COVID-19

Drug Alcohol Depend. 2021 Nov 1:228:109100. doi: 10.1016/j.drugalcdep.2021.109100. Epub 2021 Sep 23.

Authors

Erin Fanning Madden¹, Bryson T Christian², Pooja A Lagisetty³, Bradley R Ray⁴, Sandra H Sulzer⁵

Affiliations

¹ Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave., Detroit, MI 48201, USA. Electronic address: efmadden@wayne.edu.
² Oberlin College, 38 E. College St., Oberlin, OH 44074, USA.
³ Division of General Medicine, University of Michigan Medical School, 7300 Medical Science Building I, 1301 Catherine St., Ann Arbor, MI 48109, USA.
⁴ School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA.
⁵ Office of Health Equity & Community Engagement, Utah State University, 7000 Old Main Hill, Logan, UT 84322, USA.

Abstract

Background: The loosening of U.S. methadone regulations during the COVID-19 pandemic expanded calls for methadone reform. This study examines professional perceptions of methadone take-home dose regulation before and during the COVID-19 pandemic to understand responses to varied methadone distribution policies.

Methods: Fifty-nine substance use disorder treatment professionals were interviewed between 2017 and 2020 in-person or over video call. An inductive iterative coding process was used to analyze the data. Constructivist grounded theory guided the collection and analysis of in-depth interviews.

Results: Treatment professionals expressed mixed views toward methadone take-home regulations. Participants justified regulation using several arguments: 1) patient care benefitting from supervision, 2) attributing improved patient safety to take-home regulation, 3) fearing liability for methadone-related harms, and 4) relying on buprenorphine as an "escape hatch" for patients who cannot manage MMT policies. Other professionals suggested partial deregulation, while others strongly opposed pre-pandemic take-home regulation, explaining such regulations impede medication access and hinder patient-centered care. Some professionals supported the COVID-19 policy changes and saw these as a test run for broader deregulation, while others framed the changes as temporary and cautiously applied deregulation to their services, at times revoking looser rules for patients they perceived as nonadherent.

Conclusion: Treatment professionals working in a range of modalities, including opioid treatment programs, expressed hesitation toward expanded take-home methadone access. While some participants also supported forms of deregulation, post-pandemic efforts to extend looser methadone distribution policies will have to address apprehensive professionals if such policy changes are to be meaningfully adopted in community services.

Keywords: Access to care; COVID-19; Methadone maintenance treatment; Opioid treatment program; Regulation; Take-home medication.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

COVID-19*
Humans
Methadone / therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Pandemics
Perception
SARS-CoV-2

Substances

Methadone