Background
SUD
DISORDER, VIRUS, EMERGENCY
Methadone treatment provided through opioid treatment programs (OTPs) is the most highly regulated substance use disorder (SUD) treatment in the USA [Prior to the 2020 COVID-19 Public Health Emergency, OTP regulations contained certain requirements for treatment, including limitations on take home doses based on patient’s tenure in treatment and eight measures of progress (e.g., absence of “abuse” of drugs and alcohol, regular clinic attendance, lack of behavioral problems at the program), limitations on the clinical role of non-physician practitioners (e.g., nurse practitioners, physician assistants), restrictions on which disciplines can administer/dispense methadone, and requiring an in-person physical exam for admission. The regulations also required OTPs to provide an adequate availability of counseling, typically in-person. For some patients, these requirements for medication administration and counseling created barriers to treatment entry and retention [The COVID-19 pandemic fundamentally changed the way methadone treatment was delivered by limiting the number of patients in OTPs at any given time to allow physical distancing to reduce the possibility of transmission of the virus [