Comparison of Regular Versus After Hours Admissions to a 24-hour Opioid Treatment Program.

Abstract

October of 2017 marked the opening of the first US Opioid Treatment Program (OTP) that was staffed 24 hours a day, 7 days a week, with admissions on demand, both during normal OTP working hours and outside the hours when most OTPs are able to accept new patients. This article compares demographic and treatment outcomes for those patients admitted during normal working hours with those admitted after hours or on weekends. All admissions to the 24-hour OTP between January 2018 and December 2020 who were new to treatment at this OTP and started on methadone were included. An internal database of patient demographics and dosing events was collected during the normal treatment process. These data were examined regarding initial demographics, dosing, and treatment outcomes, comparing patients admitted during normal working hours with those admitted when most OTPs would be closed and unable to admit new patients. A total of 7,334 admissions were included, 2,631 during normal working hours, and 4,703 after hours or on weekends. After-hours patients were comparable in age but were more likely to be male (56.0% vs. 52.5%, P < 0.01), employed (24.1% vs. 22.1%, P < 0.05), and White versus non-White (56.2% vs. 51.5%, P < 0.001) compared with working-hour admissions. Outcomes of first-day dose, 30th-day dose, and 30-day treatment attendance did not differ between the 2 groups. In this situation where patients could be admitted at any time, the majority presented after hours. Patients who were admitted after-hours did not have worse treatment outcomes than those who were admitted during working hours. These findings suggest that offering OTP admission after-hours and on weekends will not result in attracting patients with low motivation and poorer outcomes than those who are admitted during working hours. Extending OTP admission hours has the potential to improve medication for opioid use disorder access and treatment outcomes.