Leveraging Regulatory Flexibility for Methadone Take-Home Dosing to Improve Retention in Treatment for Opioid Use Disorder: A Stepped-Wedge Randomized Trial to Facilitate Clinic-Level Changes

Prime Institution: New York University

During the COVID-19 public health emergency, regulations relaxed for take-home dosing of methadone, offering an opportunity to improve retention in care and address racial and ethnic disparities. This project aims to develop and evaluate an intervention in Opioid Treatment Programs to change clinical practice and address regulatory, legal liability, and financial concerns in New York. In Phase 1, investigators will assess data from state administrative databases and conduct qualitative interviews to inform the intervention approach. In Phase 2, investigators will evaluate an Opioid Treatment Program intervention employing take-home methadone using a stepped-wedge trial design across the state. The trial will test the effect of the intervention on take-home dosing, retention in care, and health care events, examining differential effects for Black/African American and Latinx clients. The study will inform the national debate about the benefits and harms of flexible take-home methadone dosing for patients with opioid use disorder.

Charlie Neighbors

Charlie Neighbors, MBA, PhD, New York University, MPI

Dr. Neighbors is a behavioral scientist who brings together clinical, statistical, and business expertise to understand and inform about health care reform and its impact on individuals struggling with addictions and mental health disorders. His research focuses on examining the quality and efficiency of the current treatment system for Substance Use Disorders (SUDs), studying the impact of system reform efforts, and bringing evidence-based interventions to practice. Part of his research involves analyses of large administrative databases (e.g., Medicaid) to examine characteristics of the SUD treatment as well as the use of quasi-experimental methods to study the impact of system reform interventions. He has done most of this work in New York State, relying on a strong collaborative partnership with state regulatory agencies (notably, the Office of Addiction Services and Supports [OASAS] and the Department of Health [DOH]). He is also the director of the Health Evaluation and Analytics Lab (HEAL), a joint initiative of NYU Langone’s Department of Population Health and NYU Wagner Graduate School of Public Service. HEAL’s mission is to conduct research and evaluations that assist in the administration of the New York Medicaid program and contribute to national scholarship on health and health care. They conduct and support applied research to help health care and community-based organizations deliver services that significantly improve health and well-being, particularly for vulnerable communities. Central to their lab is a large dataset called the New York State Medicaid claims file that they built to support research focused on the most disadvantaged New Yorkers. They use these data for much of their applied research, and they make the dataset available to researchers across our institution and at other universities and organizations both in and outside of New York State.

Yuhua Bao

Yuhua Bao, PhD, Weill Cornell Medical, MPI

Dr. Bao is Professor and health economist in the Department of Population Health Sciences, Weill Cornell Medicine. Her research centers on aligning incentives with evidence-based, integrated care for people with mental health and/or substance use conditions. One type of incentive she studies are provider payment models that adequately cover the costs of care but also provide incentives for doing what works best for patients and their families. Her work is funded by multiple NIH institutes and major foundations. In this HD2A project, she is leading the development of a financial planning tool to support the decisions surrounding flexible take-home dosing of methadone by Opioid Treatment Programs.

Headshot of Ashly Jordan

Ashly Jordan, PhD, MPH

Ashly Jordan is an interdisciplinary epidemiologist with more than 15 years of applied public health practice and academic research experience. Dr Jordan’s work is grounded in social justice and in principles of equity and harm reduction. The aim of her work is centered on collaboratively developing sustainable and evidence-based policies and programs. She is focused on using rigorous and pragmatic research and program effectiveness assessments to identify the role of structural and intersectional inequities in producing and re-producing contexts that create disparate conditions that differentially privilege groups of people.