ORN Summer 2025 - State sequence analysis of daily methadone dispensing trajectories among individuals at United States opioid treatment programs before and following COVID-19 onset-2025-09-03

Video Transcription

Video Summary

The webinar presented research on methadone maintenance treatment (MMT) dispensing patterns before and after COVID-19 regulatory changes across nine US opioid treatment programs (OTPs). The study utilized state sequence analysis to examine daily methadone dispensing trajectories among new patients over six months. Pre-COVID regulations required daily in-clinic dosing during the first 90 days, with limited take-home doses, while post-COVID policies allowed increased take-homes, up to seven in the first two weeks. The study found an overall modest increase in take-home doses after COVID-19, but few patients received extended consecutive take-homes, with most still required to attend clinics at least weekly. Importantly, retention rates and missed dosing did not differ significantly before and after the pandemic.<br /><br />Clinic site was the strongest factor influencing methadone dispensing trajectories rather than patient characteristics, indicating that local clinic policies and culture play a major role. Certain patient factors, like methamphetamine use or homelessness, were associated with more missed doses and poorer retention, especially post-COVID. The research emphasized the value of person-centered treatment and noted that systemic barriers, state policies, and clinic-level practices impact methadone accessibility and dosing schedules. The impact of payment models and funding structures on dispensing practices was also highlighted.<br /><br />The presenters underscored the potential of state sequence analysis to elucidate complex longitudinal treatment patterns using routine healthcare data. They noted ongoing policy shifts in methadone delivery, including expansions in mobile methadone units, pharmacy dispensing, and proposed waivers for prescribing in primary care, with audience feedback favoring mobile units and pharmacy access as priorities to improve methadone access and retention. The discussion acknowledged challenges in individualized treatment decisions, especially in large clinics, and the need for more qualitative and implementation research to understand clinic decision-making processes. Overall, the study contributes important evidence to inform policy and clinical practice amid evolving regulatory landscapes for MMT in the US.

Keywords

methadone maintenance treatment

COVID-19 regulatory changes

opioid treatment programs

state sequence analysis

take-home methadone doses

clinic site influence

patient retention

methamphetamine use impact

person-centered treatment

mobile methadone units