Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey

Minhee L Sung; Anne C Black; Derek Blevins; Brandy F Henry; Kathryn Cates-Wessel; Michael A Dawes; Holly Hagle; Paul J Joudrey; Todd Molfenter; Frances R Levin; David A Fiellin; E Jennifer Edelman

doi:10.1097/ADM.0000000000001388

Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey

J Addict Med. 2024 Oct 30. doi: 10.1097/ADM.0000000000001388. Online ahead of print.

Authors

Minhee L Sung¹, Anne C Black, Derek Blevins, Brandy F Henry, Kathryn Cates-Wessel, Michael A Dawes, Holly Hagle, Paul J Joudrey, Todd Molfenter, Frances R Levin, David A Fiellin, E Jennifer Edelman

Affiliation

¹ From the Pain Research, Informatics, Multimorbidities and Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT (MLS, ACB); Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (MLS, DAF, EJE); Section of General Internal Medicine, Yale School of Medicine, New Haven, CT (MLS, ACB, DAF, EJE); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (DB, FRL); Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY (DB, FRL); Consortium on Substance Use and Addiction, Social Science Research Institute, Pennsylvania State University, University Park, PA (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); VA Boston Healthcare System, Boston, MA (MAD); Department of Psychiatry, Boston University Medical Center, Boston, MA (MAD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO (HH); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (PJJ); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison, WI (TM); Department of Emergency Medicine, Yale School of Medicine, New Haven, CT & Yale School of Public Health, New Haven, CT (DAF); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE).

PMID: 39475119
DOI: 10.1097/ADM.0000000000001388

Abstract

Background: Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone.

Methods: We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting "The opportunity for patients to receive office-based methadone" when asked "Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?" Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone.

Results: Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19-6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02-2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04-3.09]), providing methadone (AOR [95% CI], 1.71 [1.03-2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11-3.16]).

Conclusions: A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.