BACKGROUND: Methadone is a highly effective, strictly regulated medication to treat opioid use disorder. COVID-19 flexibilities allowed for up to 28 days of take-homes versus daily travel to clinics for observed dosing, but receiving take-homes differed widely across clinics and individuals. We examined the relationship between state take-home policies and social vulnerability on take-home methadone receipt and days’ supply.
METHODS: Data were from the VOICES study, a telephone survey conducted between 1/2023–8/2024 of people who use drugs from Wisconsin, Michigan, New Mexico, and New Jersey. We estimated average marginal effects of state methadone policy (flexibility-adoption vs non-adoption) on methadone take-home receipt and days’ supply. Models were fully adjusted for individual sociodemographic characteristics.
RESULTS: Most participants were recruited from flexibility-adoption states (n = 285/428, 67%). Over half received take-home methadone (65%; average 3.1 days’ supply, SD 6.2); 19% of take-home recipients (n = 54) received >/=3 days’ supply. Take-home receipt was higher for participants in flexibility-adoption states (AME 0.52, p < 0.0001). Receiving >/=3 days’ supply was lower in people reporting unemployment (vs. employment, AME -0.23, p = 0.0032) and past 30-day drug use (vs. no drug use, AME -0.23, p = 0.0014).
CONCLUSIONS: State take-home policy was most strongly associated with take-home methadone receipt. Receiving longer days of take-home supplies remains rare. Take-home eligibility guidelines should be established and consider potential social vulnerability factors to daily on-site dosing.
Differences in take-home methadone receipt by state policy and individual social factors in a multistate survey of people who use drugs: A cross-sectional study
Journal of Substance Use and Addiction Treatment, 184, 209909. doi: 10.1016/j.josat.2026.209909.