Take-Home Opioid Agonist Therapy during Pandemic Lowered Treatment Interruption

Tara Gomes, PhD

During the COVID-19 pandemic, the amount of take-home doses of opioid agonist therapy (OAT) was allowed to increase in Ontario, Canada. A retrospective cohort study examined if this was associated with treatment retention or opioid-related harm.

The results showed that this practice was signifcantly associated with lower rates of treatment interruption and discontinuation among some subsets of patients. There were no significant increases in opioid-related overdoses.

Tara Gomes, PhD, St Michael's Hospital, and the team of investigators stated that their findings should be interpreted cautiously and may be susceptible to residual confounding.

Modified Guidance for OAT

The guidance for opioid agonist therapy was modified to allow prescribers to increase the number of take-home doses of methadone or buprenorphine/naloxone in hopes of promoting treatment retention throughout the quaratine period of the pandemic.

Opioid agonst therapies reduce the risks of relapse and death among individuals with opioid use disorder. However, investigators noted that the retention rates within 6 months ranges from 30%-50% according to previous research.

A challenge to treatment retention is the requirement of prolonged daily observed dosing, which takes place at opioid treatment centers or pharmacies. Before the pandemic, patients had to meet strict criteria before they're permitted any take-home doses.

The conitnuation of opioid agonist treatment is crucial in lowering rates of overdose deaths and relapse among these individuals.

"Therefore, in light of concerns about pandemic-associated health care disruptions and the need for physical distancing during an ongoing overdose crisis, measures to support continued access to OAT were rapidly implemented in many countries," investigators wrote.

Study Measures and Outcomes

Primary outcomes of the study were opioid overdose, interruption in opioid agonist therapy, and opioid agonist therapy discontinuation. Investigators defined exposure as extended take-home doses in the first month of the pandemic within each of 4 cohorts.

The cohorts were based on opioid agonist type and the baseline take-home dose frequency--daily dispensed methadone, 5-6 take-home doses of methadone, daily dispensed buprenorphine/naloxone, and 5-6 take-home doses of buprenorphine/naloxone.

Investigators conducted the retrospective propensity-weighted cohort study by assessing changes in take-home dose frequency from March 2020-April 2020. After that, to determine outcomes, patients were observed for up to 180 days, with the final follow-up in October 2020.

Interpreting the Results

Individuals who received daily dispensed methadone (5852) and were transitioned to take-home doses showed a significant association of lower risk of opioid use, treatment discontinuation, and treatment interruption compared with individuals who had no change in take-home doses.

Investigators found no significant difference in outcomes between exposure groups among individuals who received daily dispensed buprenorphine/naloxone (662).

For those who received weekly dispensed treatment, extended take-home methadone doses were significantly associated with lower risks of discontinuation, and therapy interruption. Extended take-home doses of buprenorphine/naloxone were also associated with lower risk of interruption of therapy compared with no change change in take-home doses.

Investigators noted that there were no significant increases in opioid-related overdoses within 6 months being examined. Ultimately, reduced rates of treatment interruption and discontinuation were observed some groups that received take-home therapies.

The study, "Association Between Increased Dispensing of Opioid Agonist Therapy Take-Home Doses and Opioid Overdose and Treatment Interruption and Discontinuation" was published in JAMA.