County-Level Uptake of Take-Home Methadone and Adverse Events Among Commercially Insured Individuals

Objectives: To maintain access to methadone treatment for opioid use disorder (OUD)—an ongoing public health issue in the United States—the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented policy changes allowing states to expand take-home methadone doses during and after the COVID-19 pandemic. This study examined the association between county-level uptake of take-home methadone, under the policy changes, on adverse events (overdose rates, hospitalizations and emergency department ED visits) and methadone treatment continuity among adults with OUD. Methods: Using difference-in-differences methodology, we analyzed administrative claims between January 2016 and April 2024 from commercially insured members of a large US health insurer, comparing outcomes between counties that had any uptake of take-home methadone and counties that had no uptake. Results: Any county-level uptake of take-home methadone was not associated with a difference in rates of opioid and other drug overdoses, behavioral health (BH)-related or OUD-related ED visits or hospitalizations, or methadone continuity. Conclusions: Findings suggest that expanding access to take-home methadone may not increase public health risks, supporting implementation of policies that encourage take-home methadone dosing for eligible individuals with OUD.