Methadone dosing at New York State opioid treatment programs following initial revisions to federal regulations

• Published in: Drug and alcohol dependence 2024-05, Vol.258, p.111283-111283, Article 111283
• Main Authors: Jordan, Ashly E., Bachhuber, Marcus A., Tuazon, Ellenie, Jimenez, Christian, Lincourt, Pat, Hussain, Shazia, Rubinfeld, Jason, Cunningham, Chinazo O.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Cohort Studies; Female; Health policy; Humans; Male; Medicaid; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Middle Aged; New York; Opiate Substitution Treatment - methods; Opioid Use Disorder; Opioid-Related Disorders - drug therapy; Overdose; Retrospective Studies; United States
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2024.111283

In March 2020, a temporary federal regulatory exemption for opioid treatment programs (OTPs) was issued, allowing for a greater number of take-home methadone doses than was previously permitted. In the same month, to address financial sustainability, New York State (NYS) Medicaid also transitioned to a bundle reimbursement methodology for OTPs. We examined methadone dosing schedules in NYS before and after these regulatory and financing changes. We conducted a retrospective cohort study using NYS OTP patient data from two sources: the client data system for a baseline period (February 2020) and survey data collected after regulatory and financing changes (May 2020 to August 2021, 64 weekly surveys). We compared methadone dosing schedules over time using chi-square tests and Poisson regression. At baseline, data were available for 78% (n=77/99) of OTPs including 90.9% (n=26,225/28,839) of their enrolled patients. During the survey period, 99 OTPs completed 93.1% (n=5901/6336) of weekly surveys, with a mean statewide weekly patient census of 38,904 (SD=1214.5). Between February and May 2020, daily dosing significantly decreased from 55.4% to 16.3% of patients (-39.1 percentage points [95%CI: −39.8 to −38.4]), although it significantly increased subsequently (3.33%/4-weeks [95%CI: 3.28, 3.39]). In addition, weekly-to-monthly dosing significantly increased from 26.9% to 54.5% of patients (27.6 percentage points [95%CI: 26.9, 28.4]), although it significantly decreased subsequently (-1.19%/4-weeks [95%CI: −1.23, −1.15]). Despite large initial changes, we found a trend toward gradual return to more restrictive dosing schedules. OTPs need further support in leveraging new opportunities to improve methadone treatment and outcomes. •As the overdose crisis worsens, providing access to lifesaving methadone is crucial.•Temporary federal regulations revisions allowed methadone take-home flexibilities.•NYS methadone dosing changed in response but changes narrowed over time.•With changes now permanent there is an unprecedented opportunity to transform methadone treatment.•It is essential for public agencies to support programs to leverage this opportunity.