Flexible access to methadone during the pandemic associated with greater likelihood of staying on treatment for opioid use disorder: study

From Unity Health Toronto

New research has found an Ontario provincial guidance change during the early days of the COVID-19 pandemic that recommended that individuals receive rapid access to take-home doses of medication for their opioid use disorder helped people stay on their treatment without increasing their risk of overdose in the subsequent six months.

The research, published in JAMA and led by researchers at St. Michael’s Hospital of Unity Health Toronto, suggests that providing people with more flexible access to their medication for opioid use disorder could be a successful strategy to keep patients in treatment and while not increasing the risk of overdose.

New guidance recommending low barrier access to take-home doses of opioid agonist therapies (OAT) was introduced on March 22, 2020 to accommodate COVID-19 public health measures, including limiting trips outside one’s place of residence, distancing requirements and isolation requirements.

People receiving OAT, such as methadone, are typically required to go to a pharmacy each day to consume their dose under medical supervision. Once they are stabilized on treatment and with agreement from their clinician, they are able to begin receiving doses to consume at home, typically beginning with one observed dose, followed by one take-home dose, and increasing over time. With the changing guidance in March 2020, the goal was to more quickly provide people with multiple take-home doses based on their clinician’s assessment of their social stability and ability to store doses safely.

“For a long time, people with opioid use disorder have been asking for more flexible access to OAT,” said Dr. Tara Gomes, lead author of the study, a Scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a Principal Investigator of the Ontario Drug Policy Research Network (ODPRN).

“It can be hard to hold down a job, go on vacation, or maintain some degree of autonomy and freedom on a day-to-day basis when accessing opioid agonist therapies because you are so tied to visiting a pharmacy on a daily basis. This pandemic-related change in guidance allowed us to see what would happen if these rigid rules were changed, and the findings suggest that more flexible treatment is actually safe and helps keep people in OAT programs.”

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