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Developing and validating measures of take-home methadone with administrative data.

Shashi N Kapadia1, Kenneth Karan2, Hao Zhang3

  • 1Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, 10065, USA.

Journal of Substance Use and Addiction Treatment
|October 22, 2025
PubMed
Summary

New methods using Medicaid claims data can effectively measure take-home methadone (THM) treatment for opioid use disorder. These validated indicators allow for better assessment of THM uptake and patient outcomes.

Keywords:
Medicaidadministrative datahealth servicesmethadoneopioid use disordertake-home

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Area of Science:

  • Health Services Research
  • Substance Abuse Treatment
  • Health Informatics

Background:

  • Take-home methadone (THM) has become more flexible since 2020, offering innovative treatment for opioid use disorder.
  • Current insurance claims data lack established methods for accurately measuring THM.
  • This study aimed to develop and validate candidate measures for THM using claims data.

Purpose of the Study:

  • To propose and validate candidate indicators for measuring take-home methadone (THM) treatment using Medicaid insurance claims data.
  • To assess the performance of these candidate indicators against a gold-standard measure.
  • To determine the extent to which variation between treatment programs explains overall variation in THM receipt.

Main Methods:

  • Utilized 2020 Medicaid data from four states, analyzing treatment episodes for individuals aged 18-64.
  • Defined THM receipt based on a gold-standard indicator (≥6 consecutive days of THM in the second month of treatment).
  • Developed four candidate indicators based on intervals between in-clinic methadone administrations and evaluated their sensitivity and specificity against the gold-standard.

Main Results:

  • The study analyzed 4836 treatment episodes, with 14% involving THM.
  • Candidate indicators demonstrated high sensitivity (65-100%) and specificity (80-96%).
  • The most sensitive indicator identified THM with any ≥7-day gap between administrations; the most specific required two consecutive ≥7-day gaps of equal length. Between-program variation accounted for 38.6-48.3% of THM receipt variation.

Conclusions:

  • Two proposed indicators for measuring THM using Medicaid claims data show excellent performance.
  • These validated measures provide a reliable method for assessing THM uptake and patient outcomes in opioid use disorder treatment.