New Study Highlights Lingering Problems in Methadone Treatment

Author: Lauren Sawyer

At the time, it seemed — and most would agree — that ‘at-home’ methadone treatment was a public health necessity during the lockdown stages of the pandemic. Others still applaud the idea of a less restrictive and more accessible approach to the treatment.

A new study now reveals some interesting patient opinions concerning at-home methadone treatment, and those opinions are mixed.

Among those polled, three words started to trend: liberating, destabilizing, unjust.

Do these opinions relate to methadone treatment distribution and processes only during pandemic times? Or is it a sign of deeper problems in methadone treatment overall?

Addressing Problems in Methadone Treatment as Overdoses Increase

In the early stages of the pandemic, the United States faced the deadly effects of two public health crises colliding: the opioid epidemic and the COVID-19 pandemic. In May 2020, drug overdose deaths had increased by 58 percent from 2019.

Increased rates of depression, anxiety, and social isolation are thought to have contributed to the stark rise in deaths.

Access to substance use disorder treatment and harm reduction services also decreased while overdoses increased. Not surprising, but researchers point out that people with opioid use disorders and other mental and physical health problems were – and still are – at a much greater risk of struggling during the pandemic.

The standard treatment for opioid use disorder is medication-assisted treatment (MAT), which has historically been heavily regulated in America. However, as the COVID-19 took over the U.S., leading agencies began to reduce barriers to care.

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA) revised some of the restrictions around MAT. Some MAT treatment participants were able to access a 14- to a 28-day supply of methadone, depending on where they were in their treatment.

SAMHSA also endorsed virtual counseling, and the Drug Enforcement Agency (DEA) allowed telemedicine for the prescription of buprenorphine. Additionally, treatment centers began reducing the frequency of urine analysis and increased patient access to telemedicine.

Access to Addiction Care During the Pandemic

You may think that loosening restrictions during the pandemic positively impacted the treatment patients received. After all,  providers reported increased staff support and an expansion of MAT (buprenorphine).

However, that was not necessarily the case for patients. Studies about opioid treatment during the pandemic – so far – had been very one-sided. They tended to focus on the delivery of care from a clinical point of view, rather than patient experience.

This new study offered patient opinions and context. Given the high prevalence of overdose among the group, researchers decided to interview opioid overdose survivors.

The study interviewed participants for up to an hour about:

• Methadone treatment
• Buprenorphine treatment
• Behavioral health treatment
• Harm reduction services (such as syringe service programs)

Sixty-five percent of participants reported that pandemic-related treatment methods had a negative impact. However, others had no problems in methadone treatment.

Many Found At-Home Method Treatment Liberating

Thirty-five percent of participants described the changes in services as liberating. Jayla, a participant in the study, explained:

“When the coronavirus came, me and my husband had never missed a group…we [never] gave [the methadone clinic] a dirty urine.”

“So, me and my husband, apiece, we have six bottles. So, we only go to the clinic once a week, and in two months, we’re going to get another three bottles …I like it because I can do anything [with] my time. I go and I stay in bed, or I can get up. I can make coffee, drink my coffee, go back to bed. Lay down. When you got to go to the clinic, you got to go to the clinic.”

Others Described the Problem in Methadone Treatment as Destabilizing

Forty percent of participants described the changes as destabilizing. Viviana, a study participant, was stable on her methadone treatment and was housed. However, the changes to treatment were disruptive. She had fewer connections and social support.

She explained:

“When you’re on the clinic, you go every single day, which means you got to get up and leave the house, and just go. Now, they were giving people take-homes, which means some people got three, and six, whatever.”

“I ended up getting six bottles so I could stay home. In a way, it helped me, but then in a way it hurts too because I started that feeling again of not leaving the house…I think I probably shouldn’t have got any take-homes and just continued going daily, and seeing the nurses and the counselors that were there.”

Some Found Pandemic-Related Treatment Changes as Simply Unjust

Twenty-five percent of participants described how the changes to addiction treatment policies were unjustly distributed. They also mentioned how some changes did not adequately mitigate the issues posed by the pandemic.

Aiden told researchers:

“It’s also been very difficult trying to stay clear of the virus…I ended up getting COVID, and I ended up having to be placed in a quarantine in a hotel for two weeks. So I had a hard time getting my dose, ‘cause I couldn’t get there daily. I need to have the dose brought to me….”

“And since then, I had to go to the clinic daily after that…I didn’t qualify for take-homes. I don’t have a home to take [methadone] to. I didn’t qualify for a lockbox full of meds that I could give to anybody that was in a position of being able to watch me.”

“Because nobody’s in that position over me, I’m homeless. These are the roads and the bumps and the twists and turns that people don’t understand that addicts, we deal with a lot of bullshit because we’re the black sheep of the community.”

Do Policy Changes Reflect Other Problems in Methadone Treatment?

Researchers noted that many patients found receiving methadone more challenging than expected. Patients also felt MAT via telemedicine was less impactful to their overall recovery.

Researchers concluded that patient-centered care may be crucial to the success of medication-assisted treatment. They also suggested integrating patient perspectives and resource considerations – such as housing and transportation ­– is important when treatment planning.

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