Retention and critical outcomes among new methadone maintenance patients following extended take-home reforms: a retrospective observational cohort study

Arthur Robin Williams; Noa Krawczyk; Mei-Chen Hu; Lexa Harpel; Nicole Aydinoglo; Magdalena Cerda; John Rotrosen; Edward V Nunes

doi:10.1016/j.lana.2023.100636

Retention and critical outcomes among new methadone maintenance patients following extended take-home reforms: a retrospective observational cohort study

Lancet Reg Health Am. 2023 Dec 4:28:100636. doi: 10.1016/j.lana.2023.100636. eCollection 2023 Dec.

Authors

Arthur Robin Williams^{1

2}, Noa Krawczyk³, Mei-Chen Hu², Lexa Harpel², Nicole Aydinoglo², Magdalena Cerda³, John Rotrosen³, Edward V Nunes^{1

2}

Affiliations

¹ Columbia University Department of Psychiatry, New York, USA.
² New York State Psychiatric Institute, New York, USA.
³ Department of Population Health, NYU Grossman School of Medicine, USA.

Abstract

Background: Approximately 1800 opioid treatment programs (OTPs) in the US dispense methadone to upwards of 400,000 patients with opioid use disorder (OUD) annually, operating under longstanding highly restrictive guidelines. OTPs were granted novel flexibilities beginning March 15, 2020, allowing for reduced visit frequency and extended take-home doses to minimize COVID exposure with great variation across states and sites. We sought to use electronic health records to compare retention in treatment, opioid use, and adverse events among patients newly entering methadone maintenance in the post-reform period in comparison with year-ago, unexposed, controls.

Methods: Retrospective observational cohort study across 9 OTPs, geographically dispersed, in the National Institute of Drug Abuse (NIDA) Clinical Trials Network. Newly enrolled patients between April 15 and October 14, 2020 (post-COVID, reform period) v. March 15-September 14, 2019 (pre-COVID, control period) were assessed. The primary outcome was 6-month retention. Secondary outcomes were opioid use and adverse events including emergency department visits, hospitalizations, and overdose.

Findings: 821 individuals were newly admitted in the post-COVID and year-ago control periods, average age of 38.3 (SD 11.1), 58.9% male. The only difference across pre- and post-reform groups was the prevalence of psychostimulant use disorder (25.7% vs 32.9%, p = 0.02). Retention was non-inferior (60.0% vs 60.1%) as were hazards of adverse events in the aggregate (X² (1) = 0.55, p = 0.46) in the post-COVID period. However, rates of month-level opioid use were higher among post-COVID intakes compared to pre-COVID controls (64.8% vs 51.1%, p < 0.001). Moderator analyses accounting for stimulant use and site-level variation in take-home schedules did not change findings.

Interpretation: Policies allowing for extended take-home schedules were not associated with worse retention or adverse events despite slightly elevated rates of measured opioid use while in care. Relaxed guidelines were not associated with measurable increased harms and findings could inform future studies with prospective trials.

Funding: USDHHSNIDACTNUG1DA013035-15.

Keywords: COVID-19; Methadone; Opioid treatment programs; Opioid use disorder.

Abstract

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