Methadone Program Directors’ Perceptions of Barriers and Supports to Engage People with Opioid Use Disorders in Methadone Services

Background: Methadone programs to treat opioid use disorder (OUD) are highly regulated, but many of their restrictions were relaxed during COVID-19, such as expanded medication take-home privileges and telehealth access. Many of these reforms have been sustained post-COVID-19, but substantial risks for overdose persist nationally. Identifying non-pandemic factors that improve service access and utilization is crucial to prevent additional mortality. Objectives: The goal of this study was to identify key stakeholder recommendations for improving methadone services and reducing treatment barriers. Results: In this study, 9 of the 10 program directors of methadone service programs in Philadelphia were surveyed in April-June 2023. The expansion of take-home privileges was perceived as beneficial for treatment access; however, additional changes to service delivery were deemed necessary to further improve outcomes. Specifically, program directors consistently identified staffing challenges (e.g., recruitment, retention, quality) as critical barriers to patient access and retention within their programs, suggesting an urgent need to invest in the substance use workforce. Program directors noted the importance of addressing other social determinants of health to improve service use, such as assistance with basic needs (e.g., housing, transportation, and benefits) and social factors (e.g., stigma). Directors perceived reduced patient demand as adversely affecting service use. Some attributed this to changes in the drug supply (e.g., fentanyl, xylazine) as well as a shift in patient preferences towards other forms of medication for opioid use disorder (MOUD). Conclusions: Program directors of methadone outpatient treatment programs identified important policies, workforce factors, and resources required to improve substance use services to address the rapidly evolving drug crisis.