State sequence analysis of daily methadone dispensing trajectories among individuals at United States opioid treatment programs before and following COVID-19 onset

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-02-26 DOI:10.1111/add.70008

Ignacio Bórquez, Arthur R. Williams, Mei-Chen Hu, Marc Scott, Maureen T. Stewart, Lexa Harpel, Nicole Aydinoglo, Magdalena Cerdá, John Rotrosen, Edward V. Nunes, Noa Krawczyk

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引用次数: 0

Abstract

Background and aims

US regulatory changes allowed for additional methadone take-home doses following COVID-19 onset. How dispensing practices changed and which factors drove variation remains unexplored. We determined daily methadone dispensing trajectories over six months before and after regulatory changes due to COVID-19 using state sequence analysis and explored correlates.

Design

Retrospective chart review of electronic health records.

Settings

Nine opioid treatment programs (OTPs) across nine US states.

Participants

Adults initiating treatment in 2019 (n = 328) vs. initiating 1 month after the COVID-19 regulatory changes of March 2020 (n = 376).

Measurements

Type of daily methadone medication encounter (in-clinic, weekend/holiday take-home, take-home, missed dose, discontinued) based on OTP clinic; cohort (pre vs. post-COVID-19); and patient substance use, clinical and sociodemographic characteristics.

Findings

Following COVID-19 regulatory changes, allotted methadone take-home doses increased from 3.5% to 13.8% of total person-days in treatment within the first 6 months in care. Clinic site accounted for the greatest variation in methadone dispensing (6.2% and 9.5% of the variation of discrepancy between sequences pre- and post-COVID-19, respectively). People who co-use methamphetamine had a greater increase in take-homes than people who did not use methamphetamine (from 3.7% pre-pandemic to 21.2% post-pandemic vs. 3.5% to 12.5%) and higher discontinuation (average 3.6 vs. 4.7 months among people who did not use methamphetamine pre-COVID-19; average 3.3 vs. 4.6 months post-COVID-19). In the post-COVID-19 cohort, females had a higher proportion of missed doses (17.2% vs. 11.9%) than males. People experiencing houselessness had a higher proportion of missed doses (19% vs. 12.3%) and shorter stays (average 3.5 vs. 4.5 months) when compared with those with stable housing.

Conclusion

Daily methadone dispensing trajectories in the US both before and following COVID-19 regulatory changes appeared to depend more on the opioid treatment programs' practices than individual patient characteristics or response to treatment.

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COVID-19发病前后美国阿片类药物治疗项目个体每日美沙酮配药轨迹的州序列分析

背景和目的：美国的监管变化允许在COVID-19发病后增加美沙酮带回家剂量。配药实践是如何改变的，哪些因素导致了变化，这些仍未得到探索。我们使用状态序列分析确定了COVID-19监管变化前后六个月内的每日美沙酮分配轨迹，并探索了相关性。设计：电子健康记录的回顾性图表审查。背景：美国九个州的九个阿片类药物治疗项目（OTPs）。参与者：2019年开始治疗的成年人（n = 328）与2020年3月COVID-19法规变化后1个月开始治疗的成年人（n = 376）。测量：基于OTP临床的每日美沙酮用药类型（门诊、周末/假日带回家、带回家、漏服剂量、停药）；队列（covid -19之前与之后）；病人的药物使用，临床和社会人口学特征。研究结果：随着COVID-19法规的变化，在治疗的前6个月内，分配的美沙酮带回家剂量从治疗总人次的3.5%增加到13.8%。临床地点在美沙酮配药方面的差异最大（分别占新冠肺炎前后序列差异的6.2%和9.5%）。共同使用甲基苯丙胺的人比不使用甲基苯丙胺的人带回家量增加更多（从大流行前的3.7%增加到大流行后的21.2%，从3.5%增加到12.5%），并且停药率更高(在covid -19之前未使用甲基苯丙胺的人平均3.6个月比4.7个月；平均3.3个月对4.6个月)。在covid -19后队列中，女性错过剂量的比例（17.2%对11.9%）高于男性。与有稳定住房的人相比，无家可归的人错过剂量的比例更高（19%对12.3%），停留时间更短（平均3.5个月对4.5个月）。结论：美国在COVID-19之前和之后的每日美沙酮分配轨迹似乎更多地取决于阿片类药物治疗方案的实践，而不是个体患者的特征或对治疗的反应。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.