Abstract
BackgroundMethadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids. Yet, MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. In response, this article examines how clinics’ take-home dosing policies have affected patients’ experiences of treatment and lives in general.MethodsThis article is based on semi-structured, qualitative interviews with a variety of stakeholders in MMT. Interviews explored: reasons for engaging with, or not engaging with MMT; how MMT is conceptualized by patients and treatment providers (e.g., as harm reduction or route to abstinence and/or recovery); experiences with MMT; perception of barriers to MMT (e.g., organizational/regulatory, social) and how MMT might be improved to support peoples’ substance use treatment needs and goals.ResultsNearly all of the patients with past or present MMT use were highly critical of the limited access to take-home doses and consequent need for daily or near daily clinic attendance. Participants described how the use of restrictive take-home dose policies negatively impacted their ability to meet day-to-day responsibilities and also cited the need for daily attendance as a reason for quitting or avoiding OAT. Responses also demonstrate how such policies contribute to an environment of cruelty and stigma within many clinics that exposes this already-stigmatized population to additional trauma.ConclusionsTake-home dose policies in MMT are not working for a substantial number of patients and are reasonably seen by participants as degrading and dehumanizing. Revision of MMT regulations and policies regarding take home doses are essential to improve patient satisfaction and the quality and effectiveness of MMT as a key evidence-based treatment and harm reduction strategy.
Highlights
Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids
It is unpopular among many people who use illegal opioids [5, 6] and its effectiveness has been hindered by consistently low rates of uptake and retention [7] that prevent it from meeting its potential as a harm reduction and public health intervention [8, 9]
Regulations Federal regulations mandate that when patients begin MMT they must go to their clinic every day to ingest their daily methadone dosage under direct observation by clinic staff [14]
Summary
[1,2,3,4] It is unpopular among many people who use illegal opioids [5, 6] and its effectiveness has been hindered by consistently low rates of uptake and retention [7] that prevent it from meeting its potential as a harm reduction and public health intervention [8, 9]. MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. As patients accumulate time at the clinic and test negative for illicit opioids on screens given at least once a month they are provided “take-home doses” of methadone to be used on days when clinic attendance is not required. There is substantial diversity among individual clinics in regard to how many take-home doses are allowed and under what circumstances they are provided [11, 16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
