Treatment provider perceptions of take-home methadone regulation before and during COVID-19
Authors: Pooja A Lagisetty
Bryson T Christian
Sandra H Sulzer
Bradley R Ray
Erin Fanning Madden
Journal: Drug and Alcohol Dependence (2021)
Discipline: NEUROSCIENCE & BEHAVIOR
Keywords: Access to care; COVID-19; Methadone maintenance treatment; Opioid treatment program; Regulation
Affiliations: Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave., Detroit, MI 48201, USA. Electronic address: ., Oberlin College, 38 E. College St., Oberlin, OH 44074, USA., Division of General Medicine, University of Michigan Medical School, 7300 Medical Science Building I, 1301 Catherine St., Ann Arbor, MI 48109, USA., School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA., 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. 

Retracted: No

PubPeer comments:
 This manuscript addresses a timely and important topic. The third-paragraph notes that u201cRegulation of MMT remained stagnant until the COVID-19 pandemic prompted a substantial relaxation of key areas of U.S. pharmacotherapy regulation on March 16, 2021, u2026u201d. This regulation was on March 16 or 2020 (1). **Citation** 1. Substance Abuse and Mental Health Services Administration. Opioid Treatment Program (OTP) Guidance. Rockville, MD; 2020. https: www. samhsa.gov sites default files otp-guidance-20200316.pdf. Accessed 26 Dec 2021. ,