Divergent Perspectives on Directly Observed Methadone Treatment and Alternative Dispensing Models

Methadone maintenance therapy is an effective treatment for opioid use disorder (OUD), which has been shown to significantly decrease drug-related and total mortality. Nevertheless, the issue of medication availability and the prevention of misuse and diversion is still a concern. This study investigated the differences between patients and healthcare professionals regarding directly observed therapy (DOT) and possible alternatives, such as unobserved take-home administration and video-observed therapy (VOT), in Portugal.

A cross-sectional study was carried out between May and August 2023 among adults with OUD undergoing methadone treatment and healthcare professionals involved in their treatment. Semi-structured questionnaires were used to collect data on experiences with DOT, attitudes towards unobserved take-home administration and VOT, and possible positive or negative impacts on daily life and treatment outcomes.

The sample consisted of 30 patients and 35 professionals. Professionals rated DOT as having a significantly more positive impact on patients' lives and treatment outcomes than patients (p < 0.001), while patients rated a significantly greater negative impact (p < 0.001). Patients rated take-home dosing as more appropriate than professionals (p < 0.001), although both groups rated dispensing frequencies of 1-3 times per week as preferred (p = 0.002). Similarly, VOT was rated more favorably by patients than by professionals (p < 0.001).

Divergent views between patients and professionals underscore the importance of developing individualized methadone dosing approaches that integrate safety and patient autonomy to maximize patient engagement and retention in OAT.