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Assessing for Variation in Methadone Take-Home Dose Prescribing by Race at the Beginning of the COVID-19 Pandemic
18 Pages Posted: 24 Dec 2024
More...Abstract
Background: COVID-19 led to a paradigm shift in opioid use disorder (OUD) treatment, with rapid access to increased methadone take-home dose (THD) amounts following publication of the Substance Abuse and Mental Health Services Administration waiver. This waiver allowed each opioid treatment program (OTP) to determine who was eligible to receive increased THD amounts. In this study, we aimed to assess whether there were any racial differences in how the waiver was applied.
Methods: We conducted a retrospective chart review of 300 individuals at one OTP in the Northeastern United States. Data collection took place from March to May 2023 and included a range of demographic and treatment characteristics gathered on intake, quarterly treatment plans, or individual medicating encounters in the months before or after implementation of the waiver. All individuals enrolled in treatment throughout implementation of the waiver (March 17 to April 14, 2020) were eligible for inclusion in the study. We used multiple variable logistic regression for our primary analysis.
Outcomes: We used four primary outcome measures: whether an individual was deemed stable (1) before or (2) after implementation of the waiver, and whether an individual received (3) any THD increase or (4) the correct THD increase as outlined by OPT guidelines. In our final models, we adjusted for clinic site, age (with quadratic transformation), gender, education status, employment status, substance use disorder diagnosis (excluding OUD), time in treatment, methadone dose, and time on THD amount prior to implementation of the waiver. None of the crude or adjusted models achieved statistical significance.
Interpretation: Our findings suggest that there were no racial differences in how the waiver was applied within this OTP. Further studies are needed to determine whether these findings can be replicated across programs that used different criteria when implementing the waiver.
Funding: American Psychiatric Association Foundation (APAF)
Declaration of Interest: We declare no competing interests.
Ethical Approval: Our methods were reviewed and approved by the Institutional Review Boards at both the Yale School of Medicine and New York University Grossman School of Medicine.
Keywords: Opioid use disorder, methadone, racial disparities, COVID-19
Suggested Citation: Suggested Citation