Expanding Access to Methadone Treatment for Justice Involved Individuals through Video Direct Observed Therapy (059)


Study Information

Patients with Opioid Use Disorder (OUD) who are recently released from prison are at high risk of overdose when they re-enter the community, both due to reduced opioid tolerance and the psychological stress of reintegration. They also face unique challenges in accessing treatment for OUD, including transportation barriers, unstable housing, limited financial resources, and parole requirements. This makes the daily in-person methadone dosing requirement of Opioid Treatment Programs (OTPs) particularly burdensome. Asynchronous Video Direct Observed Therapy (VDOT) has been successfully utilized for public health programs to ensure treatment compliance for patients undergoing treatment for tuberculosis and has been trialed for treatment of Substance Use Disorders (SUDs) as well. Initial studies have shown that increased take home doses allowed during the Covid-19 pandemic did not increase overdose deaths or methadone negative urine drug screens (UDS). We propose to use VDOT technology to expand access to methadone treatment for justice involved populations. We hypothesize that asynchronous VDOT will increase adherence to methadone dosing, improve patient satisfaction, and reduce barriers to care without increasing negative treatment outcomes. Aim 1: we will assess the feasibility and patient acceptability of VDOT for methadone maintenance therapy through patient surveys, chart reviews of clinic attendance, and monitoring of patient videos through a VDOT application platform. Aim 2: we will evaluate the safety and efficacy of the VDOT intervention by examining the following treatment outcomes: 1) Methadone positive and negative UDS; 2) Illicit opioid positive and negative drugs screens; 3) Non opioid illicit drug positive and negative UDS; 4) Alcohol positive and negative urine screens; 5) opioid related mortality including overdose deaths; and 6) all-cause mortality. The study will also assess retention rates in methadone treatment.

Study Team

PI: Christine Neeb, M.D.

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Research Type

J-RIG Award