ABSTRACT
BACKGROUND: Methadone reduces opioid-related harms and overdose deaths in those with opioid use disorder (OUD) yet in the US is restricted to federal and state-regulated opioid treatment programs (OTPs). Methadone access remains limited, particularly in rural settings. We sought to determine prescriber and practice characteristics associated with support for provision of methadone through office-based settings. METHODS: We performed a secondary analysis of the Opioid Use Disorder Provider COVID-19 Survey, a survey collaboratively developed with multistakeholder input to explore the impact of COVID-19-related practice changes among X-waivered buprenorphine prescribers. Data were collected from July to August 2020 electronically and analyses herein were restricted to prescribers who provided outpatient, longitudinal care for adults with OUD. The outcome variable was selecting “The opportunity for patients to receive office-based methadone” when asked “Which of the pandemic-related federal policy changes or new policy changes would you like to be continued after the pandemic?” Sequential multivariable logistic regression analyses were performed to determine prescriber and practice characteristics associated with support for the opportunity for patients to receive office-based methadone. RESULTS: Among invited participants, 1,900 initiated and completed the survey. Among the 739 respondents included in the analysis, 52% were men, 60% were ≥50 years old, 81% were White, 39% were board certified in Addiction Medicine/Psychiatry, 44% were practicing in family medicine or internal medicine, and 20% in psychiatry. Nineteen percent had prescribed medications to treat OUD (MOUD) for ≥15 years, 20% had ordered methadone previously, and 21% worked in OTPs. Twenty-nine percent indicated support for office-based methadone. In sequential multivariable logistic regression models, factors associated with support for office-based methadone, compared to being White, were being Asian (AOR=2.23;95% [CI] = 1.01, 5.04), Black/African-American (AOR=3.36;95% [CI] = 1.30, 8.71);having prescribed MOUD for ≥15 years (OR=2.06;95% [CI] = 1.15, 3.66) compared to 0-5 years;having ordered methadone previously (AOR=1.71;95% [CI] = 1.03, 2.83) or having prescribed injectable naltrexone previously (AOR=1.70;95% [CI] = 1.14, 2.56) compared to not prescribing MOUD previously;and working in an academic medical center (AOR=1.87;95% [CI] = 1.11, 3.14) compared to working in other clinical practice settings. CONCLUSIONS: Nearly a third of X-waivered buprenorphine prescribers supported provision of office-based methadone, specifically prescribers of Asian, Black, or African-American backgrounds, who had spent a longer time treating OUD, and had experience providing methadone. Future efforts should explore pathways to include office-based methadone to improve access to OUD treatment.