County-Level Uptake of Take-Home Methadone and Adverse Events Among Commercially Insured Individuals.

Abstract

To maintain access to methadone treatment for opioid use disorder (OUD)-an ongoing public health issue in the United States-the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented policy changes allowing states to expand take-home methadone doses during and after the COVID-19 pandemic. This study examined the association between county-level uptake of take-home methadone, under the policy changes, on adverse events (overdose rates, hospitalizations and emergency department [ED] visits) and methadone treatment continuity among adults with OUD. Using difference-in-differences methodology, we analyzed administrative claims between January 2016 and April 2024 from commercially insured members of a large US health insurer, comparing outcomes between counties that had any uptake of take-home methadone and counties that had no uptake. Any county-level uptake of take-home methadone was not associated with a difference in rates of opioid and other drug overdoses, behavioral health (BH)-related or OUD-related ED visits or hospitalizations, or methadone continuity. Findings suggest that expanding access to take-home methadone may not increase public health risks, supporting implementation of policies that encourage take-home methadone dosing for eligible individuals with OUD.