Effectiveness of take-home methadone treatment among patients with opioid use disorders during COVID-19: A systematic review

Background

The COVID-19 pandemic has exacerbated the global overdose crisis, increased opioid-related deaths and highlighted the need for innovative treatment strategies. This study critically evaluates the efficacy of take-home methadone for patients with opioid use disorders (OUDs) during public health emergencies.

Methods

Adhering to PRISMA reporting guidelines, this systematic review scrutinized RCTs and quasi-experimental studies on opioid agonist treatments (OATs), notably methadone, from Medline, Web of Science (core collection), Embase, Cochrane Library, and Scopus, spanning January 2020 to May 2024. It targeted global patients of any age, contrasting take-home methadone with in-clinic dosing, omitting non-English studies or those solely analyzing program delivery modifications without take-home dose discussions. Key outcomes included emergency room (ER) visits, treatment retention, overdose rates, alongside secondary outcomes like patient health, quality of life (QoL), and satisfaction. Registered with PROSPERO (CRD42023474723), the review prioritized treatment impacts and language inclusivity.

Findings

The final search yielded 1,222 records, with two studies included (four records). Despite included only two studies (four records) due to a focused selection criterion, findings indicate overall participant satisfaction with take-home methadone, suggesting its potential as a viable treatment modality during public health emergencies. However, the limited study number and focus on indirect outcome measures underscore the need for further comprehensive research.

Interpretation

This review champions flexible dosing, technology integration, and stigma reduction in OUD treatment, urging longitudinal research on take-home methadone's continued impacts. Despite constraints, it enriches OUD management for enhanced public health outcomes, highlighting future research avenues.