Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis

BackgroundAccess to medications for opioid use disorder (MOUD) in the U.S. is highly restricted. In March 2020, to reduce transmission of COVID-19, SAMHSA issued emergency regulations allowing up to two weeks of take-home doses for most patients. ObjectivesWe evaluated the benefits and unintended consequences of these new regulations expanding take-home eligibility to inform MOUD policy post-pandemic MethodsWe conducted a mixed-methods evaluation of an opioid treatment program in San Francisco caring for a diverse, low-income urban population. We assessed clinic-level intake, retention, and take-home prescribing; individual-level acute care utilization and mortality; and patient/provider perceptions of benefits, harms and challenges of the new regulations. ResultsClinic volume, intake and retention were largely unchanged after implementation of the new regulations, though the average monthly proportion of individuals receiving take-homes significantly increased from 31% to 47% (p<0.001). Among 506 established patients ([&ge;]90 days of care), the 10-month mortality was 2.7% among those who never received take-homes versus 3.2% among those newly started (p=0.79) and 0.8% among those with increases in take-homes (p=0.24). Individuals who never received take-homes had higher rates of emergency department visits (47.0%) and hospitalizations (19.7%) versus those with new starts (ED visits 29.2%, p<0.001; hospitalizations 14.3%, p=0.19) or increases in take-homes (ED visits 17.5%, p<0.001; hospitalizations 10.0%, p=0.02). Both patients and providers reported increased treatment flexibility, leading to increased engagement and stabilization. ConclusionsGiven the benefit and lack of appreciable harms, policymakers should consider extending expanded MOUD take-home eligibility after COVID-19, with careful monitoring for unintended outcomes.