Methadone Treatment Practice in a Changing Landscape: Limited Early Adoption of the Federal Final Rule Among U.S. Opioid Treatment Programs

BACKGROUND: U.S. COVID-era methadone treatment flexibilities were made permanent through the federal "Final Rule." This study reports opioid treatment program (OTP) early adoption of expanded telehealth services and flexible dosing between the Final Rule's effective and compliance dates (April 2 and October 2, 2024). METHODS: A cross-sectional online survey was conducted from June 21 to August 14, 2024, among a national convenience sample of 154 OTP administrators. Measures included Final Rule-allowed telehealth services, flexible dosing and clinic dosing requirements. Covariates included rurality, clinic type, state law expanding or limiting methadone access, and whether the clinic was in a county with an opioid overdose death rate exceeding the national median. RESULTS: Forty-four OTP administrators from 21 states completed surveys. Most (90.9%) offered COVID-era telehealth counseling, however expanded telehealth services were limited such as allowing initial health assessments (36.4%), health examinations by telehealth with medication pickup (22.7%), and initial medical examinations via telehealth (15.9%). Clinics required that 52.9% their patients complete daily in-clinic dosing. Multiday "take home" dosing options offered by clinics to over half their patients included 7-days of take-home doses during the first 14 treatment days (18.2% of clinics), 14-days of take-home doses after 15 days of treatment (18.2%), and 28 days of take-home doses after 30 days of treatment (15.9%). CONCLUSIONS: Evidence of early adoption of the 2024 federal Final Rule (42 CFR §8) was not observed among most opioid treatment programs in this sample.