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Area of Science:

  • Addiction Medicine
  • Public Health Policy
  • Qualitative Research Methods

Background:

  • COVID-19 emergency waivers allowed opioid treatment programs (OTPs) greater flexibility, including take-home methadone doses and telehealth.
  • These changes were generally welcomed by patients and clinicians without apparent negative impacts on safety.
  • However, adoption varied, with some OTPs reverting to pre-pandemic practices.

Purpose of the Study:

  • To examine variations in clinical practices across U.S. Department of Veterans Affairs (VA) OTPs following regulatory flexibility.
  • To understand the beliefs and perspectives of OTP administrators influencing decisions on adopting programmatic changes.

Main Methods:

  • Qualitative study involving semi-structured interviews with administrators from 28 out of 33 VA OTPs.
  • Data analyzed using an inductive-deductive approach with the framework method for cross-site comparison.

Main Results:

  • Diverse policies were observed regarding take-home doses, toxicology testing, and group attendance requirements.
  • Telehealth utilization increased broadly; however, adoption of other flexibilities depended on administrators' perceptions of risk and therapeutic impact.
  • Administrators desired guidance for consistent and equitable care despite appreciating treatment individualization.

Conclusions:

  • Significant variation exists in VA OTP clinical practices following regulatory reforms.
  • Further research is needed to evaluate the impact of these clinical practices on patient engagement, retention, and quality of care in the evolving regulatory landscape.