Faculty Bibliography

Background and Objectives/UNASSIGNED:Here we aimed to characterize clinical outcomes in those receiving treatment at a Veterans Health Administration (VHA) methadone maintenance treatment program (MMT) during the COVID 19 pandemic in which SAMSHA regulations for MMTs were changed to provide a greater number of methadone allotments and decreased clinic-visit frequency. Methods/UNASSIGNED:We report results of a single-site, pre-post cohort study of urine drug screen data 3 months before and after an increase in allotments of take-home medication from the methadone clinic. One hundred twenty-nine patients met inclusion criteria for this study. The study was reviewed by the NYHHS IRB committee and granted final approval by the Research and Development Committee. Results/UNASSIGNED: > .05), number of new medical illnesses or overdoses. We controlled for participant age, substance use disorder diagnosis, psychiatric disorder diagnosis, and number of years in treatment. Discussion/Conclusions/UNASSIGNED:The results of the study illustrate the relative safety of the changes made at this particular MMT during the pandemic. Additionally, there was continued adherence to methadone treatment with minimal change in illicit substance use during period 1 and period 2. Scientific Significance/UNASSIGNED:To these authors' knowledge this paper is one of the first to examine clinical outcomes in those with opioid addiction prescribed methadone from MMTs during the COVID 19 pandemic.

Maintaining patient safety and continuity of care is of the utmost importance in methadone treatment. However, many patients face considerable barriers for entry into methadone maintenance therapy (MMT). The pre-COVID19 requirements for patients enrolled in methadone treatment may pose an additional such barrier to patients with work or travel obligations. Therefore, it is imperative that federal methadone policy strike an appropriate balance between the interests of patient retention and safety and the interests of access to care. These considerations are particularly important in the context of current and future infectious diseases outbreaks or other crises. The necessity of strict methadone policies for opioid use disorder should continue to be explored with further research studies. XXBackground(s): To facilitate social distancing during the COVID- 19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) has permitted clinicians discretion to prescribe up to 28 days of take-home methadone doses to patients in opioid treatment programs (OTPs) regardless of patients' duration of prior treatment. Previously, the United States had long maintained take-home restrictions aimed at preventing overdose and diversion, but the effectiveness of these restrictions and of supervised consumption of methadone overall have been poorly studied. XXObjective(s): Determine the effects of early access to takehome doses on treatment retention in MMT. Examine the risk of overdose given early access to take-home methadone doses. Characterize the effectiveness of implementation of emergency methadone policies in the context of a public health crisis. XXMethod(s): Following the SAMHSA restriction changes, in March 2020 the OTP at the Veterans Affairs New York Harbor Health System in Manhattan suspended new patient enrollment and offered current patients between 4 and 28 days of take-home methadone, based on clinician assessment of patient risk. The proposed study will perform a retrospective chart review comparing the rates of patient dropout and illicit drug overdose in the 3 months prior to these changes to the rates in the 3 months following. XXResult(s): Results are forthcoming pending IRB approval. XXConclusion(s): Conclusions are forthcoming pending IRB approval. Scientific Significance: This will be the first study of its kind to examine changes in SAMHSA's take-home methadone schedule and patient outcomes in times of crisis. Of note, New York City OTPs and their patients have struggled to maintain continuity of care during other states of emergency, such as 9/11 and Hurricane Sandy. Thus, the results may further inform the approach to regulatory oversight of methadone prescription during states of disaster

Attrition from treatment for substance abuse disorders is a persistent challenge that severely limits the effectiveness of services. Although a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients' stated reasons for leaving outpatient treatment (n = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors. Program-level barriers include dissatisfaction with the program, especially counselors; unmet social services needs; and lack of flexibility in scheduling. Individual-level barriers to retention were low problem recognition and substance use. Study limitations are noted, and the implications of findings for research and practice are discussed, emphasizing the need to understand and address clients' needs and expectations starting at intake to maximize treatment retention and the likelihood of positive outcomes

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of on-site 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step on-site, were followed for one year post-treatment. On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance