Addiction Research
The Impact of Relaxation of Methadone Take-Home Protocols on Treatment Outcomes in the COVID-19 Era
Background
In response to the COVID-19 pandemic, the US Substance Abuse and Mental Health Services Administration (SAMHSA) allowed for an increase in methadone take-home doses for the treatment of Opioid Use Disorder (OUD) in March 2020.
Objective
To evaluate the effects of the SAMSHA exemption on methadone adherence and OUD-related outcomes.
Methods
A convenience sample of 183 clients (58% female) were recruited from a methadone clinic in the fall of 2019 for a cross-sectional survey. Survey data was linked to clinical records, including urine drug testing (UDT) results for methadone and emergency department (ED) visits at the local hospital. Participants were on stable methadone dosing for 9 months prior to and following March 2020. Methadone adherence was assessed by UDTs; OUD-related outcomes were assessed by overdose events and ED visits. Logistic regression was used to assess the association between change in take-home methadone doses and outcomes.
Results
Mean take-home doses increased nearly 200% (11.4 doses/30 days pre-COVID-19 vs. 22.3 post-SAMHSA exemption). ED visits dropped from 74 (40.4%) pre-COVID-19 to 56 (30.6%) post-SAMHSA exemption (p = <0.001). No significant changes were observed in either the number of clients experiencing overdose or those who experienced one or more methadone negative UDTs in the post-SAMHSA exemption period. Adjusted models did not show a significant association between changes in take-home doses and associated outcomes.
Conclusions
Despite a near-doubling of take-home methadone doses during the COVID-19 exemption period, the increase in take-home doses was not associated with negative treatment outcomes in methadone-adherent clients.
Increased Distance Was Associated with Lower Daily Attendance to an Opioid Treatment Program in Spokane County Washington
Adherence to opioid agonist therapy using methadone is associated with improved clinical and community outcomes such as reductions in drug use, criminal behavior, high-risk sexual behavior, and mortality. Unfortunately, however, the need to have patients’ methadone ingestion witnessed at the clinic on a daily basis may comprise adherence. In this study we found significant positive associations between distance to an Opioid Treatment Program (OTP) and the number of missed doses in the first month of treatment. Findings suggest the need to improve the spatial availability of OTPs to optimize opioid use disorder treatment outcomes.
Spatial Access to Opioid Treatment Program and Alcohol and Cannabis Outlets: Analysis of Missed Doses of Methadone during the First, Second, and Third 90 Days of Treatment
Background
The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.
Objective
To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.
Methods
The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client’s home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.
Results
Shorter distance from a client’s residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.
Conclusions
Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.
Three-Year Retention in Methadone Opioid Agonist Treatment: A Survival Analysis of Clients by Dose, Area Deprivation, and Availability of Alcohol and Cannabis Outlets
The objective of this study was to determine the effect of clinical, socio-demographic, and contextual characteristics on treatment retention in an opioid treatment program (OTP).Using a retrospective longitudinal review of 851 clients who received methadone at the only state-funded OTP in Spokane County, Washington between 2015 and 2017. A time variable (the number of days in treatment) and a status indicator (to distinguish between clients who dropped out or censored) worked together to define retention in treatment. Our hypothesized covariates included: area deprivation, distance to the OTP, availability of cannabis retail outlets, availability of on-premise and off-premise alcohol outlets, methadone dosage, age, gender, race, and years on treatment. Cox regression within the family of survival analysis was used to model time-to-event data in the presence of censored cases.
That results showed that the median duration of retention was 394 (95%CI = 324–464) days. In the multivariable Cox regression, factors predicting treatment retention were area deprivation (HR = 1.79, 95%CI = 1.02–3.15, p = 0.04), age (HR=0.99, 95%CI=0.98-.99, p = 0.008), dosage of methadone (HR=0.98, 95%CI=0.98-0.98, p < 0.001), and the number of years on treatment (HR=1.12, 95%CI=1.06-1.18, p < 0.001).
The findings of this study showed age and methadone dosage were protective factors and area deprivation and years on treatment were risk factors for treatment retention. After dichotomizing methadone dosage, a unique finding of this study was that higher dosage of methadone did not lead to increasingly smaller HRs for dropping out of treatment. Considering that opioid use disorder is a chronic condition, efforts need to be made to target factors associated with retention.
Kaplan-Meier analysis of retention for 851 clients in treatment by area deprivation index. Censored treatments, those who did not leave treatment but had not been in the program for all three years, are marked.
Distance to HIV Care and Treatment Adherence: Adjusting for Socio-Demographic and Geographical Heterogeneity
Distance to health services plays an important role in determining access to care and an individual’s health. This study aims to examine the relationship between distance to antiretroviral therapy (ART) prescribing physician and adherence to HIV treatment in British Columbia, Canada. Only participants who provided highly accurate locational data for both place of residence and their physician were used in the analysis. Using logistic regression, a multivariable confounder model was created to assess the association between distance and adherence. A geographically weighted logistic regression was also performed to adjust for spatial dependency. There were 1528 participants in the analysis, for a median distance of 17.85km. The final model showed further away from ART prescribing physician had a higher chance of incomplete adherence to ART (adjusted odds ratio 1.31; 95% Confidence Interval 1.04–1.65). Mobile services could potentially increase adherence rates for population residing further away from their ART prescribing physician.
Media Exposure and Substance Use Increase during COVID-19
Background
Lockdown measures because of COVID-19 are likely to result in deteriorating physical and mental health. In this study, our aim was to assess the impact of media exposure on increases in substance use during the COVID-19 pandemic.
Methods
A nationally representative online survey of 1264 adults was collected during the pandemic in the United States. Logistic regression was used to explore the association between an increase in substance use since the beginning of the COVID-19 pandemic and exposure to cable news or social media together with COVID-19 knowledge, while controlling for covariates.
Results
Study participants with the highest exposure to social media (at least daily) and low knowledge of COVID-19 were 9.9 times more likely to experience an increase in substance use since the pandemic began. Participants with the highest exposure to cable news and low knowledge of COVID-19 were over 11 times more likely to experience an increase in substance use.
Discussion
Based on our findings, we recommend that media organizations should aim to reduce uncertainty and also provide positive coverage to counter the negative information associated with pandemics.
Conclusions
Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.