Close

Research Brief: Differences in take-home methadone receipt by state policy and individual social factors in a survey of people who use drugs

bottles of liquid medicine

Written By: Samaksh Gupta and Benjamin Eidman

Study Authors: Olivia K. Sugarman, Jirka Taylor, Samantha J. Harris, Sachini Bandara, Brendan Saloner, Noa Krawczyk

Bottom Line: State policy was most strongly associated with methadone patients receiving any take-home doses, but few patients got more than three days’ worth of methadone regardless of state policy. Findings suggest that state policy is only part of the solution to enhancing methadone take-home access; implementation within opioid treatment programs is critical to ensure that patients who would benefit from additional take-home doses can receive them. 

Background 

Methadone is an effective, highly regulated medication for opioid use disorder. To comply with federal regulations on methadone dispensing, opioid treatment programs (OTPs) have historically required most patients to come in daily for observed dosing. Daily travel limits treatment access for some patients, especially those with social vulnerabilities such as being unhoused, unemployed, or not having access to reliable transportation. Some patients could receive unsupervised “take-home” doses of methadone for Sundays and holidays, and earn additional take-home days after participating in treatment for at least 90 days. During the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented flexibilities allowing OTPs to dispense up to 28 days of take-home methadone doses. Initial research demonstrated that the take-home flexibilities were not associated with increases in methadone-involved overdose deaths; overdose deaths even decreased within some demographic groups​.1-3

SAMHSA subsequently made these flexibilities permanent through an April 2024 federal rule change. However, not all states have adopted these flexibilities and there is limited research on how state adoption of the flexibilities impact patients’ receipt of take-home methadone. A recent study from the Johns Hopkins Bloomberg Overdose Prevention Initiative Evaluation Team examined how state policies and social vulnerabilities are associated with access to and duration of take‑home methadone doses. 

Study Methods 

This study used data from the VOICES survey​4​, administered between January 2023 and August 2024. As part of the Bloomberg Overdose Prevention Initiative, VOICES was a large-scale survey with people who use drugs that focused on participants’ experiences with drug use, harm reduction, and treatment systems. Participants were recruited by peer referral and from 50 harm reduction, treatment, and social service organizations within four areas in states participating in the Bloomberg Overdose Prevention Initiative: 1) Milwaukee, Wisconsin; 2) Flint & Detroit, Michigan; 3) Statewide New Jersey; and 4) Bernalillo County, New Mexico.  

The study included VOICES respondents who reported receiving methadone in the past 30 days and compared take-home methadone receipt between participants from SAMHSA flexibility-adoption states at the time of the study (New Mexico and New Jersey) and non-adoption states (Michigan and Wisconsin). 

Study Findings 

About a fifth of VOICES survey respondents reported receiving methadone in the past 30 days. 

  • Among 2,183 respondents in the VOICES survey, 428 individuals (20%) reported receiving methadone in the past 30 days and were included as study participants. 

Receipt of take-home methadone was more common among participants in flexibility-adoption states. 

  • Out of 285 participants in states with take-home flexibilities, 240 (84%) reported receiving take-home methadone compared to 39 (27%) of 143 respondents in states without take-home flexibilities. 

Few participants received 3 days or more of take-home methadone doses, regardless of state methadone policy. 

  • Across all states, only 19% of participants receiving take-home methadone reported getting 3 days or more days of take-home doses. 
  • In flexibility-adoption states, only 17% of respondents receiving take-home methadone reported getting 3 days or more days of take-home doses. 
  • People who reported unemployment and past 30-day drug use were less likely to get additional days of take-homes. 

Study Implications 

Taken together, these findings underscore: 

  • In non-adoption states: An opportunity for state policymakers to align state take-home methadone policies with federal regulations. 
    • The probability of receiving take-home methadone was significantly higher for study participants in flexibility-adoption states, demonstrating how state policies may potentially promote access to methadone-based treatment. State policymakers in non-adoption states should consider bringing their state policies in line with SAMHSA’s 2024 rule change, which permanently adopted its pandemic take-home methadone flexibilities.  
  • In flexibility adoption states: An opportunity for State Opioid Treatment Authorities (SOTAs) and OTPs to collaborate on implementing take-home methadone eligibility guidelines. 
    • While SAMHSA’s flexibilities permit up to 28 days of take-home doses, only 17% of study participants getting take-home methadone in flexibility-adoption states got more than the usual 1-2 days of weekend take-homes. This emphasizes the important role implementation plays once states have aligned take-home methadone policies with federal flexibilities. Following such policy changes, OTPs and SOTAs, the state officials responsible for overseeing OTP compliance with federal and state laws and regulations, should focus on operationalizing take-home methadone eligibility guidelines that are patient centered, account for social vulnerability barriers to daily on-site dosing, and promote access to methadone-based treatment.  

To read the complete paper: visit JSAT

References  ​

1. Harris RA. Methadone take-home policies and associated mortality: Permitting versus non-permitting states. Substance abuse : research and treatment. 2024;18:29768357241272379. https://journals.sagepub.com/doi/full/10.1177/29768357241272379. doi: 10.1177/29768357241272379.

​2. Harris RA, Long JA, Bao Y, Mandell DS. Racial, ethnic, and sex differences in methadone-involved overdose deaths before and after the US federal policy change expanding take-home methadone doses. JAMA health forum. 2023;4(6):e231235. https://www.ncbi.nlm.nih.gov/pubmed/37294585. doi: 10.1001/jamahealthforum.2023.1235. 

​3. Jones CM, Compton WM, Han B, Baldwin G, Volkow ND. Methadone-involved overdose deaths in the US before and after federal policy changes expanding take-home methadone doses from opioid treatment programs. JAMA psychiatry (Chicago, Ill.). 2022;79(9): 932–934. http://dx.doi.org/10.1001/jamapsychiatry.2022.1776. doi: 10.1001/jamapsychiatry.2022.1776. 

​4. Bandara S, Byrne L, Berman V, et al. Harm reduction and treatment among people at high risk of overdose. JAMA Network Open. 2024;7(8):e2427241. http://dx.doi.org/10.1001/jamanetworkopen.2024.27241. doi: 10.1001/jamanetworkopen.2024.27241. 

Samaksh Gupta is a research intern for the Bloomberg Overdose Prevention Initiative. He is an undergraduate student at Johns Hopkins University studying Cognitive Science.

Benjamin Eidman, MSPH, is the Senior Research Program Coordinator for the Bloomberg Overdose Prevention Initiative. He has experience in Medicaid care coordination, implementation science research in surgical and mental health settings, and consulting for state Medicaid agencies. Benjamin works to bridge the research and policy communities, striving for policies that are both practical and informed by evidence.