Methadone Patients Research Articles

Healthcare utilisation and associated costs for methadone versus buprenorphine recipients: Examination of interlinked primary and secondary care electronic health records in England.

More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs. Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08-1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11-1006.69). Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.

A preliminary investigation of the acute effects of delta-9-tetrahydrocannabinol on pain and opioid attentional bias among persons with opioid use disorder

IntroductionAttentional bias (AB) is believed to be an important factor in the development and maintenance of both opioid use disorder (OUD) and chronic pain. Cannabis and its main psychoactive constituent, delta-9-tetrahydrocannabinol (THC), produce analgesic effects via processes that are potentially relevant to AB and is commonly used by persons with OUD. This exploratory study investigated if THC influences AB towards pain and opioid cues individuals with OUD. MethodsUsing a within-subject, crossover design, 27 adults receiving methadone were randomly assigned to receive single doses of oral THC (10 mg, 20 mg administered as dronabinol) or placebo across three, 5-h sessions. During each session, a visual probe task was used to measure AB to pain and opioid cues at baseline and 120 min post-THC administration. ResultsMixed-effects models examined main effects of THC dose, time, and their interaction across all participants; findings were then stratified by methadone dose (low dose <90 mg/day and high dose ≥90 mg/day). Among individuals receiving high doses of methadone, a significant interaction was observed such that AB towards opioids increased following 10 mg THC administration and decreased following 20 mg THC administration. Additionally, participants receiving low doses of methadone showed significant increases in the variability of opioid-related AB post THC administration. ConclusionWe provide preliminary evidence showing that THC may cause dose-dependent effects on selective attention for opioid cues among methadone patients. These results underscore the need for further clinical investigation into the effects of cannabinoids and other substances with potential analgesic and addictive properties among persons with OUD.

A Novel Use of the "3-Day Rule": Post-discharge Methadone Dosing in the Emergency Department.

Methadone is a medically necessary and lifesaving medication for many patients with opioid use disorder. To adequately address these patients' needs, methadone should be offered in the hospital, but barriers exist that limit its continuation upon discharge. The code of federal regulations allows for methadone dosing as an inpatient as well as outpatient dispensing for up to three days to facilitate linkage to treatment. As a quality initiative, we created a new workflow for discharging patients on methadone to return to the emergency department (ED) for uninterrupted dosing. Our addiction medicine team changed hospital methadone policy to better allow hospitalization as a window of opportunity to start methadone. This necessitated the creation of a warm-handoff process to link patients to methadone clinics if that linkage could not happen immediately on discharge. Thus, our team created the "ED Bridge" process, which uses the "3-day rule" to dispense methadone from the ED post hospital discharge. We then followed every patient we directed through this workflow as an observational cohort for outcomes and trends. Of the patients for whom ED bridge dosing was planned, 40.4% completed all bridge dosing and an additional 17.3% received at least one but not all bridge doses. Established methadone patients made up 38.1% of successful linkages, and 61.9% were patients who were newly started on methadone in the hospital. Improving methadone as a treatment option remains an ongoing issue for policymakers and advocates. Our ED bridge workflow allows us to expand access and continuation of methadone now using existing laws and regulations, and to better use hospitals as a point of entry into methadone treatment.

Evaluating adherence to ECG monitoring protocols for methadone patients in primary care.

Opioid Agonist Treatment (OAT) is the gold standard for managing Opioid Use Disorder (OUD). It is highly effective at reducing all-cause mortality and drug-related harms. Prescribing OAT, particularly methadone, is becoming increasingly complex as Scotland's OUD population ages. Older patients, with increased polypharmacy and multimorbidity, are more susceptible to QTc interval prolongation associated with methadone use. Therefore, adherence to ECG monitoring guidelines for patients prescribed methadone is crucial, though insights from substance use services indicate suboptimal compliance. Medically Assisted Treatment guidelines established by the Scottish Government advocate for shared care agreements, thus transferring OAT prescribing responsibilities to primary care. Understanding ECG monitoring guideline implementation in non-specialist services is vital for developing safe OAT services in primary care. This audit assessed adherence to NICE guidelines for ECG monitoring in OUD patients prescribed methadone in a Scottish primary care practice. The notes of patients prescribed methadone were assessed using NICE criteria to determine eligibility for ECG monitoring. Eligible patients' medical records were reviewed to identify previous ECG investigations. Of 21 patients prescribed methadone, 16 qualified for ECG monitoring. Only 25% of eligible patients received ECG monitoring per NICE guideline, meaning 75% did not. These findings highlight that the issue of poor compliance with ECG monitoring guidelines is not limited to specialist services, but also affects primary care. Further exploration of barriers to guideline implementation is essential. Perhaps more resources are needed to integrate OAT services into primary care, which has taken on increased responsibilities without corresponding investment.

The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine.

Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality. Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID. In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3years. Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing. Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts. Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.

Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone.

West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia's nine opioid treatment programs (OTPs) for the first time. We conducted time trend and geospatial analyses of Medicaid enrollees between 2016 and 2019 to examine medications for opioid use disorder utilization patterns following Medicaid coverage of methadone, focusing on distance to an OTP as a predictor of initiating methadone and conditional on receiving any, longer treatment duration. Following Medicaid coverage of methadone in 2018, patients receiving methadone comprised 9.5% of all Medicaid enrollees with an opioid use disorder (OUD) diagnosis and 10.6% in 2019 (P < 0.01). In 2018, two-thirds of methadone patients either had no prior OUD diagnosis or were not previously enrolled in Medicaid in our observation period. Patients residing within 20 miles of an OTP were more likely to receive methadone (marginal effect [ME]: -0.041, P < 0.001). Similarly, patients residing in metropolitan areas were more likely to receive treatment than those residing in nonmetropolitan areas (ME: -0.019, P < 0.05). Metropolitan patients traveled an average of 15 miles to an OTP; nonmetropolitan patients traveled more than twice as far (P < 0.001). We found no significant association between distance and treatment duration. West Virginia Medicaid's new methadone coverage was associated with an influx of new enrollees with OUD, many of whom had no previous OUD diagnosis or prior Medicaid enrollment. Methadone patients frequently traveled far distances for treatment, suggesting that the state needs additional OTPs and innovative methadone delivery models to improve availability.

Quality of Life, Craving Beliefs, and Psychological Well-being in Methadone Patients: The Effectiveness of Mindfulness-Based Stress Reduction Program

Quality of Life, Craving Beliefs, and Psychological Well-being in Methadone Patients: The Effectiveness of Mindfulness-Based Stress Reduction Program

Study will use OTP to look at methadone reform

A new study funded by the National Institute on Drug Abuse (NIDA) and headed by researchers interested in changing the way methadone for opioid use disorder is utilized will use Community Medical Services treatment staff and patients as research subjects. Community Medical Services operates more than 60 opioid treatment programs in 11 states, and is the first OTP, or methadone clinic, to be open around the clock in some areas, with head Nicholas Stavros incorporating novel ways to reach out to patients. The MPACT (Methadone Patient Access to Collaborative Treatment) study will develop and test a medical intervention using a $1 million NIDA grant. Researchers at the University of Arizona Health Sciences, under the direction of Beth Meyerson, Ph.D., will test a “patient‐empowered, trauma‐informed” treatment using methadone in Arizona. Meyerson is a professor, and director of the Harm Reduction Research Lab in the University of Arizona College of Medicine at Tucson. The study will take two years. “Improving methadone treatment is critical because one person dies from an opioid overdose every five minutes in this country,” said Meyerson, who is also director of policy for the University of Arizona Health Sciences Comprehensive Pain and Addiction Center. “Access to methadone has been found to reduce opioid overdoses by 80%, but it is currently being delivered in ways that can create suboptimal patient outcomes, where only 30% of patients complete treatment and over 30% experience significant treatment interruptions.” The protocol will be used to focus on how to make treatment more acceptable to patients and includes a staff‐focused intervention to reduce trauma related to actually working in the OTP. “Vicarious trauma has been found to impact both patient care and staff recognition of the need to adopt treatment and practice innovations,” Meyerson said, adding, “This study is the crucial first step in assessing MPACT's feasibility, acceptability and preliminary effects on patient and staff outcomes. Once our established milestones are reached from the pilot program, the second phase of funding will enable us to expand the study of MPACT among 30 clinics with 600 patients and 450 staff members across the U.S.” Kristen Rundell, M.D., professor and chair of the Department of Family and Community Medicine at the University of Arizona, where Meyerson's harm reduction lab is based, said the study “is a prime example of our department's emphasis of social justice through medicine.”

Intraoperative Methadone Use in Patients Undergoing Minimally Invasive Colorectal Surgical Procedures

Abstract Background: Postoperative pain control is an important aspect in the recovery of patients. Recent literature suggests that the extended half-life of methadone may reduce overall opioid utilization in postoperative patients. However, there have yet to be any studies examining the efficacy of methadone as part of the protocol for enhanced recovery after colorectal surgery in patients. Objectives: To review the efficacy of perioperative methadone in reducing postoperative opioid usage and patient pain control. Design: Retrospective observational study. Settings: Tertiary academic center. Patients and Methods: Eighty-nine patients were identified from a prospectively maintained database having received methadone perioperatively from 2019 to 2021. These were compared to 89 historical controls identified from the same database and matched on procedure type, age, and American Society of Anesthesiology status. Main Outcome Measures: Primary outcomes were postoperative opioid use and subjective pain scores. Secondary outcomes were length of hospital stay, return of bowel function, and hospital cost. Sample Size: 89 patients receiving methadone and 89 historical control patients. Conclusions: The patients who received methadone used significantly more opioids overall compared to non-methadone patients (P = 0.015). In addition, there was no significant difference in pain scores for methadone vs non-methadone patients (P = 0.630). Furthermore, there was no difference in the length of stay and return of bowel function (P = 0.512 and P = 0.140, respectively). Moreover, opioid-naïve patients, regardless of methadone status, showed reduced average pain compared to non-naïve patients (P = 0.010 and P = 0.010, respectively). Despite support in surgical literature, we failed to find clinical benefit in including methadone as a part of the enhanced recovery pathway for patients undergoing minimally invasive colorectal surgery. Limitations: Retrospective design limited to minimally invasive techniques. Conflicts of interest The authors have no conflicts of interest to declare.

Using ADAPT-ITT framework to tailor evidence-based interventions for addressing methamphetamine use among methadone patients in Vietnam.

Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence-based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam. Following the ADAPT-ITT (Assessment-Decision-Administration-Production-Topical experts-Training-Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post-intervention feedback served to fine-tune the revised EBIs. Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family-related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs. We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability. NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

Characteristics of patients undergoing medication-assisted -treatment for opioid use disorder and their interest in Tai Chi practice.

(1) To explore the characteristics of patients with opioid use disorder (OUD) maintained on either methadone or buprenorphine and (2) to determine the relative acceptability of integrating Tai Chi (TC) practice into an ongoing medication-assisted treatment for opioid use disorder (MOUD) program. Survey study. The University of Arkansas for Medical Sciences Center for Addiction Services and Treatment Program. 97 patients receiving MOUD treatment. Drug use history, treatment status, physical limitation, mental health, pain, and whether participants were interested in using TC to improve health outcomes. At least 30.9 percent of the sample reported moderate or higher level of limitation in performing rigorous physical activities, pain intensity, and pain interference. Between 37.1 and 61.5 percent of the sample reported various psychiatric symptoms. Methadone patients reported higher levels of physical limitations, especially in rigorous activities (p = .012), climbing several flights of stairs (p = .001), and walking more than a mile (p = .011), but similar levels of pain (ps = .664-.689) and psychiatric symptoms (ps = .262-.879) relative to buprenorphine patients. At least 40.2 percent of participants expressed moderate or higher level of interest in TC for improving health outcomes, with methadone patients more interested in participating to ease mental and sleep problems (p = .005) and improve physical fitness (p = .015) compared to buprenorphine patients. High prevalence of physical limitation, pain, and psychiatric comorbidities were found in OUD patients. Since patients were interested in TC to improve their health outcomes, this low-cost intervention, if proven effective, can be integrated into ongoing MOUD programs to improve health in this population.

Cuddling better than medication for NOWS: NIH

The National Institutes of Health (NIH) has just released a study which, according to director Lawrence Tabak, D.D.S., Ph.D., shows using the “eat, sleep, console” approach for neonatal opioid withdrawal syndrome (NOWS) is better than the traditional method of giving the babies opioids, such as morphine, methadone, or buprenorphine. This has been known for years in terms of pregnant methadone patients who deliver babies with withdrawal symptoms: simply letting the baby breastfeed, live in the same room with the mother instead of being in the neonatal ICU, and get a lot of cuddling and swaddling eliminates the need for medication and reduces the hospital length of stay.

SAMHSA continues methadone take‐home flexibility

Below is information from the Substance Abuse and Mental Health Services Administration (SAMHSA) on guidance for opioid treatment programs (OTPs) on exemptions from the take‐home regulations. The exemptions continue for one year beyond the end of the COVID‐19 emergency. It ended on May 11, 2023. So OTPs can continue to provide flexible take‐homes to methadone patients, providing the appropriate criteria (listed below) are met.

0693 Rest-activity rhythm in Methadone and Buprenorphine-maintained patients

Abstract Introduction Opioid use disorder (OUD) is a chronic relapsing disorder with a high overdose death rate. In OUD, sleep and circadian disruptions are highly prevalent, interfere with retention in opioid maintenance treatment (OMT) and increase relapse. Growing evidence suggests a link between sleep/circadian disruptions and dopaminergic (DA) signaling which accounts for addictive properties of drugs of abuse. The current study investigated rest-activity rhythm in Methadone and Buprenorphine-maintained patients and how it relates to DA changes in patients. Methods To access rest-activity rhythm, twenty-five OUD patients (9 Females; age 44.34±11.97; 60% White, 32% Black; 18 Methadone; 7 Buprenorphine) and thirty-four age, sex, race and BMI-matched healthy controls wore wrist accelerometers for one-week and completed questionnaires for sleep and chronotype. Among OUD patients, sixteen of them completed [11C]NNC112 and [11C]raclopride PET scans for the assessments of D1R and D2R availability, respectively. Negative mood was accessed as secondary outcomes. Results Our preliminary data showed that compared to healthy participants, OUD patients undergoing OMT reported greater sleep problems and showed greater sleep irregularity measured by actigraphy, but no differences in other parameters such as sleep duration, rhythm timing or physical activity. Among patients, greater eveningness and irregularity were associated with higher level of negative mood including depression and anxiety. There is a tendency of a positive correlation between later phase and greater D1 receptor availability and a negative association between sleep irregularity and D2 receptor availability. Conclusion Our finding suggests that a link between altered rest-activity rhythm and DA signaling in OUD patients. Circadian/sleep interventions that regulate rest-activity rhythm might benefit mood improvement and promote OUD recovery by normalizing DA transmission. Support (if any)

NIH study supports non‐medication approach for NOWS

The National Institutes of Health (NIH) has just released research — soon to be published, according to director Lawrence Tabak, D.D.S., Ph.D. last week — that shows using the “eat, sleep, console” approach for neonatal opioid withdrawal syndrome (NOWS) is better than the traditional method of giving the babies opioids, such as morphine, methadone, or buprenorphine. This has been known for years in terms of pregnant methadone patients who deliver babies with withdrawal symptoms: Simply letting the baby breastfeed, live in the same room with the mother instead of being in the neonatal ICU, and get a lot of cuddling and swaddling eliminates the need for medication and reduces the hospital length of stay. Using the NIH HEAL Initiative's Advancing Clinical Trials program, one study evaluated the eat, sleep, console approach compared to usual care in 26 hospitals, said Tabak, speaking at last week's Rx and Illicit Drug Summit in Atlanta. The eat, sleep, console approach “substantially decreased the time until infants were medically ready for discharge, did not affect safety outcomes through three months of age, and provides strong support,” said Tabak, adding that it should be the standard care for NOWS.

Patient experiences of methadone treatment changes during the first wave of COVID-19: a national community-driven survey

BackgroundDuring COVID-19, the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed Methadone Maintenance Treatment (MMT) programs to relax in-person MMT requirements to reduce COVID-19 exposure. This study examines patient-reported changes to in-person methadone clinic attendance requirements during COVID-19.MethodsFrom June 7, 2020, to July 15, 2020, a convenience sample of methadone patients (N = 392) were recruited in collaboration with National Survivors Union (NSU) in 43 states and Washington D.C. through social media (Facebook, Reddit, Twitter, and Web site pop-ups). The community-driven research (CDR) online survey collected information on how patient take-home methadone dosing and in-person drug testing, counseling, and clinic visit frequency changed prior to COVID-19 (before March 2020) to during COVID-19 (June and July 2020).ResultsDuring the study time period, the percentage of respondents receiving at least 14 days of take-home doses increased from 22 to 53%, while the percentage receiving one or no take-home doses decreased from 22.4% before COVID-19 to 10.2% during COVID-19. In-person counseling attendance decreased from 82.9% to 19.4%. While only 3.3% of respondents accessed counseling through telehealth before COVID-19, this percentage increased to 61.7% during COVID-19. Many respondents (41.3%) reported visiting their clinics in person once a week or more during COVID-19.ConclusionsDuring the first wave of COVID-19, methadone patients report decreased in-person clinic attendance and increased take-home doses and use of telehealth for counseling services. However, respondents reported considerable variations, and many were still required to make frequent in-person clinic visits, which put patients at risk of COVID-19 exposure. Relaxations of MMT in-person requirements during COVID-19 should be consistently implemented and made permanent, and patient experiences of these changes should be explored further.

Targeting of methadone patients angers OTP operator in Alabama

Allegations that authorities in Alabama are unfairly singling out methadone patients have become top of mind for an opioid treatment program (OTP) owner in the state. The issue hit particularly close to home last month for Susan Staats‐Combs, M.Ed., owner of Shelby County Treatment Center, as positive methadone tests for one of her employees and the woman's newborn triggered a hospital's report to the state and a home visit from the state Department of Human Resources (DHR).

Substance use among methadone patients in Vietnam: a systematic review

ABSTRACT Background Despite the increasing popularity of methadone maintenance treatment (MMT) in Vietnam, little is known regarding the substance use patterns of Vietnamese MMT patients. With it being almost 15 years since the inception of MMT in Vietnam, it felt timely to undertake a systematic review on this topic. Objectives We conducted a systematic review of the peer-reviewed literature regarding substance use among MMT patients in Vietnam with three main objectives: 1) identify which types of substances are being used, 2) identify the extent of use (i.e., prevalence), and 3) identify knowledge gaps regarding drug use patterns. Methods After systematically searching four bibliographic databases (PubMed, Web of Science, ScienceDirect, and PsycINFO), we included 20 studies involving 6,653 participants, published between 2012-2021 with 14 unique samples. Results Findings indicate that, on average, 81% of MMT patients used tobacco, 47% used alcohol, 32% used heroin, 24% engaged in injection drug use, and 12% used illicit drugs. Conclusion These results suggest that substance use is an active issue among Vietnamese MMT patients that warrants closer attention. These data can be used by providers to inform which/how interventions are targeted at MMT patients in Vietnam and help lower the number of overdoses seen across the country.

Home sensors may help detect withdrawal during sleeping hours

Methadone patients typically take one dose a day in the morning. By the time they take their next dose, 24 hours later, they are not in withdrawal, but will be soon. Some patients may actually be near withdrawal before then if they are not getting enough methadone. A recent study has found that smart home sensors could help these patients, who might relapse if their nighttime withdrawal symptoms aren't addressed. One major complaint of people in early treatment for opioid use disorder (OUD) is disrupted sleep — indeed, a problem for people who are dependent on opioids in general, including opioids for pain. A pilot study published in Pain Management Nursing by researchers from Washington State University showed that these sensors could provide information about overnight sleep problems for people recovering from OUD. The researchers found that the home sensors matched other monitoring methods (using videos and wires) for sleep disturbance 89% of the time. “One day, when people go home from addiction treatment, we could send them to a smart home sensor environment, so we can know remotely if they're struggling to sleep and getting up and down a lot,” said lead author Marian Wilson, a WSU nursing professor. “We know that poor sleep is a trigger for substance use and could lead to unintended overdose,” Wilson said. Wilson's study found that detecting issues such as breathing problems and physical movements could help alert health care professionals of the need for medication changes or other interventions. In addition, the findings validated what patients had been saying. “Our study confirms what people with opioid use disorder have been saying — their sleep can be restless and disturbed,” said Wilson in a press release from the university. “We need to appreciate that people may be suffering. There's a misconception that substance use is all about that euphoric ‘high.’ By the time people get into a methadone treatment program, they're usually just trying to feel normal.” In the future, patients don't need to come into the sleep lab to be observed, and instead could just use the home sensors in an unobtrusive way, with no videos or cameras, Wilson added. The research was conducted in a lab. The next step will be to test the home sensor in homes. The research was supported by the National Institutes of Health and the Rayce Rudeen Foundation.

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID.

ObjectiveTo understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic.MethodsThis community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access.ResultsTelehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options.ConclusionsMOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.