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

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.