{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:57:01Z","timestamp":1791341821234,"version":"4.3.1"},"reference-count":42,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51\u2009years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.<\/jats:p>","DOI":"10.1080\/08897077.2022.2060438","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T09:42:20Z","timestamp":1651484540000},"page":"1147-1154","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":47,"title":["\u201cThe Idea is to Help People Achieve Greater Success and Liberty\u201d: A Qualitative Study of Expanded Methadone Take-Home access in Opioid use Disorder Treatment"],"prefix":"10.1177","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4786-356X","authenticated-orcid":false,"given":"Leslie W.","family":"Suen","sequence":"first","affiliation":[{"name":"UCSF National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA"},{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Castellanos","sequence":"additional","affiliation":[{"name":"UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA"},{"name":"Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Satterwhite","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of California, Davis, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5838-8592","authenticated-orcid":false,"given":"Kelly R.","family":"Knight","sequence":"additional","affiliation":[{"name":"Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"bibr1-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1169"},{"key":"bibr2-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2020.1318"},{"key":"bibr3-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170958"},{"key":"bibr4-08897077.2022.2060438","unstructured":"Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: A Treatment Improvement Protocol. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004."},{"key":"bibr5-08897077.2022.2060438","unstructured":"Substance Abuse and Mental Health Services Administration. Opioid treatment program (OTP) guidance. https:\/\/www.samhsa.gov\/sites\/default\/files\/otp-guidance-20200316.pdf Published online March 16, 2020. Accessed January 5, 2021."},{"key":"bibr6-08897077.2022.2060438","unstructured":"Substance Abuse and Mental Health Services Administration. FAQs: provision of methadone and buprenorphine for the treatment of opioid use disorder in the COVID-19 emergency; 2020. https:\/\/www.samhsa.gov\/sites\/default\/files\/faqs-for-oud-prescribing-and-dispensing.pdf"},{"key":"bibr7-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20190920.981503"},{"key":"bibr8-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1803982"},{"key":"bibr9-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2020.1752351"},{"key":"bibr10-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2020.108222"},{"key":"bibr11-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1111\/add.15087"},{"key":"bibr12-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-002-0041-6"},{"key":"bibr13-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.08.037"},{"key":"bibr14-08897077.2022.2060438","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2021.1975344"},{"key":"bibr15-08897077.2022.2060438","doi-asserted-by":"crossref","unstructured":"Corbin J, Strauss A.\n                      Basics of qualitative research: Techniques and procedures for developing grounded theory\n                      , 3rd ed., Sage Publications, Inc; 2008.","DOI":"10.4135\/9781452230153"},{"key":"bibr16-08897077.2022.2060438","unstructured":"National Academies of Sciences, Engineering, and Medicine. 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