Investigating Heterogeneous Effects of An Expanded Methadone Access Policy With Opioid Treatment Program Retention: a Rhode Island Population-based Retrospective Cohort Study.

Details

• Alternative Title:
  American Journal of Epidemiology, 2025, v. 194, no. 9: Investigating Heterogeneous Effects of An Expanded Methadone Access Policy With Opioid Treatment Program Retention: a Rhode Island Population-based Retrospective Cohort Study.
• Journal Article:
  American Journal of Epidemiology
• Personal Author:
  Allen, Bennett ; Krawczyk, Noa ; Basaraba, Cale ; Jent, Victoria A. ; Yedinak, Jesse L. ; Goedel, William C. ; Krieger, Maxwell ; Pratty, Claire ; Macmadu, Alexandria ; Samuels, Elizabeth A. ; Marshall, Brandon D. L. ; Neill, Daniel B. ; Cerdá, Magdalena
• Description:
  Following federal regulatory changes during the COVID-19 pandemic, Rhode Island expanded methadone access for opioid treatment programs (OTPs) in March 2020. The policy, which permitted take-home dosing for patients, contrasted with longstanding restrictions on methadone. This study used patient-level OTP admission and discharge records to compare six-month retention before and after the policy change. We conducted a retrospective cohort study of 1248 patients newly admitted to OTPs between March 18 and June 30 of 2019 (pre-policy) and 2020 (post-policy). We used logistic regression to estimate associations with retention before and after the policy and used a machine learning approach, the heterogeneous treatment effect (HTE)-Scan, to explore heterogeneity in retention across subgroups. Overall, we found no change in retention following the policy, with an adjusted OR of 1.08 (95% CI, 0.80, 1.45) and adjusted RR of 1.03 (0.90-1.18). Using HTE-Scan, we identified two subgroups with significantly increased retention above the overall cohort: (1) patients with below high-school education and past-month arrest and (2) male, non-Hispanic white or Hispanic/Latino patients reporting heroin or fentanyl use with past-month arrest. We identified no subgroups with significantly decreased retention. Collectively, findings suggest that expanded methadone access may benefit vulnerable populations without harming overall retention.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Methadone
  • Retrospective Studies
  • Male
  • Female
  • Opiate Substitution Treatment
  • Opioid-Related Disorders
  • Adult
  • Middle Aged
  • Analgesics, Opioid
  More +
• Keywords:
  • treatment retention
  • methadone
  • COVID-19
  • heterogeneous treatment effects
  • machine learning
  • Rhode Island
  • HTE-scan
• Source:
  American Journal of Epidemiology, 2025, v. 194, no. 9
• DOI:
  https://doi.org/10.1093/aje/kwaf092
• ISSN:
  0002-9262 ; 1476-6256
• Pubmed ID:
  40312833
• Pubmed Central ID:
  PMC12409131
• Document Type:
  Text
• Funding:
  K01 CE003586/CE/NCIPC CDC HHSUnited States/ ; R01 DA046620/DA/NIDA NIH HHSUnited States/ ; R01DA046620-02S1, T32DA007233/DA/NIDA NIH HHSUnited States/ ; K01CE003586/CC/CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  Rhode Island
• Pages in Document:
  2744-2754 (24 pdf pages)
• Volume:
  194
• Issue:
  9
• Download URL:
  https://stacks.cdc.gov/view/cdc/261442/cdc_261442_DS1.pdf
• File Type:
  [PDF - 267.53 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:5bf52cc9bc6eb031162ee39516fac039675df20617561fac5dfba28993e01aa09b4442eb810beaaa45f4eac32c1d5297e147510228492abeda6ffac588ec956f