Methadone

The survey collected sociodemographic information including age-group, gender identity, race/ethnicity, health insurance type, monthly out-of-pocket payments for methadone, and participant MMT clinic state and city. It also collected self-reported information on take-home dose quantities, in-person clinic visits, toxicological screens, and counseling attendance.
Participant take-home dose quantities were measured categorically as: no take-home doses, 1 per week, 2 per week, 3 per week, 4 per week, 5 per week, 6 or 7 (one week), 13 or 14 (two weeks), and 27 or 28 (one month). Overall clinic attendance was measured categorically as every day, 6 times a week, 5 times a week, 4 times a week, 3 times a week, 2 times a week, once a week, twice a month, or once a month. Counseling attendance was also measured categorically as: daily, 3 times a week, 2 times a week, weekly, 6 times a month, 3 times a month, 2 times a month, once a month, once every 3 months, and none. Method of counseling attendance was also measured categorically as: not required to attend counseling services, in person, through telehealth, by telephone, and none. Information regarding how often toxicological screens were required was measured as, “never,” “1–2 times a month,” “2–5 times a month,” “5–7 times a month,” “7–10 times a month,” “10–15 times a month,” “20 +, ” and “other” as a write-in response. Items where participants indicated they did not know or if they left the question blank, that response was considered missing. Categories were established by consulting with community members and with considerations toward the balance of sample size between groups. The survey included two write-in response questions: “What has your clinic done to maintain 6-foot social distancing between people?” and “Is there anything else you would like to tell us about your clinic's practices during COVID-19?”.

Consistent with the community-driven research (CDR) approach, this project was designed and led by people directly impacted by methadone treatment policies [47 (link), 58 (link)]. The first author, in collaboration with National Survivors Union (NSU), the national union for people who use drugs in the United States, used a CDR [47 (link)] approach to the study. CDR is particularly useful for research with marginalized populations who often have negative experiences with researchers [11 (link)]. In the CDR model, members of the impacted community are considered fundamental drivers of all aspects of the research, from initiating and developing the research questions to data interpretation, analysis, and dissemination phases of the project [9 (link)]. Our use of the CDR model emphasizes leadership capacity development for community members with living experience [58 (link)]. Since the early stages of the project were unfunded, in lieu of compensating directly impacted collaborators, the first author provided NSU members with training and contributed to NSU activities unrelated to the research.
Data for these analyses come from a national online survey NSU conducted to discover if and how MMT in-person requirements were relaxed throughout the country. The cross-sectional survey, written in English, contained 28 questions including two write-in response questions (Appendix). NSU members designed the survey questions based on their MMT experiences during COVID-19 or the experiences of methadone patients in their community. Next, an academic researcher member phrased the questions, which six NSU methadone workgroup members evaluated over four two-hour sessions and further refined. Two members tested the survey prior to distribution for inclusive and accessible language, survey length, and potentially stigmatizing or traumatizing questions. As a result of testing, the survey was shortened, phrasing and word choice changed for several questions, and write-in questions were added.
The survey was conducted from June 7, 2020, to July 15, 2020. NSU members used targeted sampling methods [46 (link)] to recruit a convenience sample of methadone patients through drug use and methadone patient social media groups (Facebook, Reddit, Web site pop-ups, and Twitter). No respondents were compensated for participation because the CDR project was unfunded. All questions were optional. The anonymous survey was short (approximately 7 min) in respect of participants’ time.
In total, 455 people participated in the survey. The study inclusion criteria were self-reported current methadone treatment in the United States. Responses were checked to ensure respondents submitted only one response. We omitted respondents who did not complete the survey or reported that they were not MMT patients in the United States. The final analytic sample comprised 392 participants from 219 cities (1 to 9 participants per city) in 43 states and Washington D.C.