{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:33:23Z","timestamp":1777984403848,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/hrbopenres.14044.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000}},{"DOI":"10.12688\/hrbopenres.14044.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000}}],"reference-count":34,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001590","name":"Health Research Board","doi-asserted-by":"publisher","award":["SDAP-2023-029"],"award-info":[{"award-number":["SDAP-2023-029"]}],"id":[{"id":"10.13039\/501100001590","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns3:p>Background It is increasingly suggested that clinical guidelines and practices be updated to permanently expand relaxation around access to opioid agonist treatment (OAT) take-home doses after COVID-19. Despite a risk of OAT drug diversion, flexibility in take-home doses is valued by patients and associated with improved quality of life and retention. However, few studies have examined the effects of changes to take-home dose policies on prescribing practices and patient outcomes, with mixed results. Aims This protocol relates to three inter-related studies. The first study will examine the impact of guidance issued on March 13th 2020 to all clinicians involved in the delivery of OAT to give the maximum number of take-home doses having given due consideration to the safety of the patient, on prescribing practices for take-home doses of methadone and buprenorphine in primary care. The second study will examine the association between increased take-home doses of OAT following March 13th 2020 guidance and treatment discontinuation in primary care. The third study will examine methadone-related deaths in Ireland before and after the guidance issue, and whether methadone-related deaths varied by whether the deceased was on OAT treatment at the time of death. Methods Retrospective observational studies will be carried out. The first study will use a time series design to examine changes in prescribing practices of take-home doses. The second study will use a retrospective cohort study design with proportional hazard Cox models to evaluate the association between increased take-home doses and treatment discontinuation. The third study will use a repeated cross-sectional study design with interrupted time series analysis, stratified by OAT treatment status, to assess changes in methadone-related deaths. Discussion It is anticipated that the studies will generate evidence with potential to inform both clinical and policy decision making with respect to take-home dosing of OAT.<\/ns3:p>","DOI":"10.12688\/hrbopenres.14044.3","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:49:08Z","timestamp":1773150548000},"page":"32","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of guidance issued during COVID-19 to expand take-home doses of opioid agonist treatment (OAT) in Ireland: protocol for a population-based analysis of prescribing practices and patient outcomes 2018 to 2023"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2985-7668","authenticated-orcid":false,"given":"Gr\u00e1inne","family":"Cousins","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5842-6747","authenticated-orcid":false,"given":"Louise","family":"Durand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2861-7665","authenticated-orcid":false,"given":"Kathleen","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"O'Hara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8491-9596","authenticated-orcid":false,"given":"Des","family":"Crowley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4635-6673","authenticated-orcid":false,"given":"Suzi","family":"Lyons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3395-3831","authenticated-orcid":false,"given":"Eamon","family":"Keenan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"1560-1579","DOI":"10.1016\/S0140-6736(19)32229-9","article-title":"Global patterns of opioid use and dependence: harms to populations, interventions, and future action.","volume":"394","author":"L Degenhardt","year":"2019","journal-title":"Lancet."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"CD002209","DOI":"10.1002\/14651858.CD002209.pub2","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.","volume":"2009","author":"R Mattick","year":"2009","journal-title":"Cochrane Database Syst Rev."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"CD002207","DOI":"10.1002\/14651858.CD002207.pub4","article-title":"Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence","volume":"2014","author":"R Mattick","year":"2014","journal-title":"Cochrane Database Syst Rev."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1484-1492","DOI":"10.1111\/j.1360-0443.2008.02249.x","article-title":"Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV\/AIDS.","volume":"103","author":"P Lawrinson","year":"2008","journal-title":"Addiction."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"979-993","DOI":"10.1001\/jamapsychiatry.2021.0976","article-title":"Association of Opioid Agonist Treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and meta-analysis.","volume":"78","author":"T Santo","year":"2021","journal-title":"JAMA Psychiatr."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"846-855","DOI":"10.1001\/jama.2022.1271","article-title":"Association between increased dispensing of Opioid Agonist Therapy take-home doses and opioid overdose and treatment interruption and discontinuation.","volume":"327","author":"T Gomes","year":"2022","journal-title":"JAMA."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0232086","DOI":"10.1371\/journal.pone.0232086","article-title":"Retention of patients in Opioid Substitution Treatment: a systematic review.","volume":"15","author":"A O\u2019Connor","year":"2020","journal-title":"PLoS One."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"103236","DOI":"10.1016\/j.drugpo.2021.103236","article-title":"Pathways between COVID-19 public health responses and increasing overdose risks: a rapid review and conceptual framework.","volume":"93","author":"T Nguyen","year":"2021","journal-title":"Int J Drug Policy."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s13722-021-00275-1","article-title":"Early innovations in Opioid Use Disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review.","volume":"16","author":"N Krawczyk","year":"2021","journal-title":"Addict Sci Clin Pract."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"301-306","DOI":"10.1017\/ipm.2021.8","article-title":"Response of tertiary addictions services to opioid dependence during the COVID-19 pandemic.","volume":"38","author":"K Hennigan","year":"2021","journal-title":"Ir J Psychol Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"108801","DOI":"10.1016\/j.jsat.2022.108801","article-title":"Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural Opioid Treatment Programs: a mixed methods analysis.","volume":"141","author":"K Hoffman","year":"2022","journal-title":"J Subst Abuse Treat."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"108154","DOI":"10.1016\/j.jsat.2020.108154","article-title":"Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: should this practice be incorporated into routine clinical care?","volume":"119","author":"J Trujols","year":"2020","journal-title":"J Subst Abuse Treat."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"932-934","DOI":"10.1001\/jamapsychiatry.2022.1776","article-title":"Methadone-involved overdose deaths in the us before and after federal policy changes expanding take-home methadone doses from Opioid Treatment Programs.","volume":"79","author":"C Jones","year":"2022","journal-title":"JAMA Psychiatr."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e238-e246","DOI":"10.1016\/S2468-2667(23)00023-3","article-title":"Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy.","volume":"8","author":"N Krawczyk","year":"2023 Mar","journal-title":"Lancet Public Health."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s13011-023-00564-9","article-title":"The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in Opioid Agonist Treatment: a mixed methods systematic review.","volume":"18","author":"A Adams","year":"2023","journal-title":"Subst Abuse Treat Prev Policy."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"103768","DOI":"10.1016\/j.drugpo.2022.103768","article-title":"Consensus recommendations for Opioid Agonist Treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: a national Delphi study.","volume":"106","author":"L Durand","year":"2022","journal-title":"Int J Drug Policy."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12954-021-00535-y","article-title":"It\u2019s like \u2018liquid handcuffs\": the effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients\u2019 lives.","volume":"18","author":"D Frank","year":"2021","journal-title":"Harm Reduct J."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"103644","DOI":"10.1016\/j.drugpo.2022.103644","article-title":"Impact of the COVID-19 pandemic on the provision of take-home doses of Opioid Agonist Therapy in Ontario, Canada: a population-based time-series analysis.","volume":"103","author":"S Kitchen","year":"2022","journal-title":"Int J Drug Policy."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e231235","DOI":"10.1001\/jamahealthforum.2023.1235","article-title":"Racial, ethnic, and sex differences in methadone-involved overdose deaths before and after the US federal policy change expanding take-home methadone doses.","volume":"4","author":"R Harris","year":"2023","journal-title":"JAMA Health Forum."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"109703","DOI":"10.1016\/j.drugalcdep.2022.109703","article-title":"Methadone-involved overdose deaths in the United States before and during the COVID-19 pandemic.","volume":"242","author":"R Kleinman","year":"2023","journal-title":"Drug Alcohol Depend."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1585-1596","DOI":"10.1111\/add.16565","article-title":"The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine.","volume":"119","author":"R Ivasiy","year":"2024","journal-title":"Addiction."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"297-306","DOI":"10.1016\/j.therap.2023.06.004","article-title":"Increase of overdose and deaths related to methadone during COVID-19 epidemic in 2020.","volume":"79","author":"E Frauger","year":"2024","journal-title":"Therapies."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"103877","DOI":"10.1016\/j.drugpo.2022.103877","article-title":"Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England.","volume":"110","author":"D Aldabergenov","year":"2022","journal-title":"Int J Drug Policy."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"209029","DOI":"10.1016\/j.josat.2023.209029","article-title":"Impact of changes to the delivery of Opioid Agonist Treatment, introduced during the COVID-19 pandemic, on treatment access and dropout in Ireland: an interrupted time series analysis.","volume":"149","author":"L Durand","year":"2023","journal-title":"J Subst Use Addict Treat."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12954-018-0272-4","article-title":"Twenty years of the Methadone Treatment Protocol in Ireland: reflections on the role of general practice.","volume":"16","author":"I Delargy","year":"2019","journal-title":"Harm Reduct J."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"108466","DOI":"10.1016\/j.drugalcdep.2020.108466","article-title":"Factors associated with early and later dropout from Methadone Maintenance Treatment in specialist addiction clinics: a six-year cohort study using proportional hazards frailty models for recurrent treatment episodes.","volume":"219","author":"L Durand","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1867-1877","DOI":"10.1111\/add.15004","article-title":"Do interruptions to the continuity of Methadone Maintenance Treatment in specialist addiction settings increase the risk of drug-related poisoning deaths? A retrospective cohort study.","volume":"115","author":"L Durand","year":"2020","journal-title":"Addiction."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"126-131","DOI":"10.1016\/j.drugalcdep.2016.12.009","article-title":"J-shaped relationship between supervised methadone consumption and retention in Methadone Maintenance Treatment (MMT) in primary care: National cohort study.","volume":"173","author":"G Cousins","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref28","doi-asserted-by":"publisher","year":"2012","DOI":"10.2810\/5285"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using Autoregressive Integrated Moving Average (ARIMA) models: a guide for evaluating large-scale health interventions.","volume":"21","author":"A Schaffer","year":"2021","journal-title":"BMC Med Res Methodol."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1866-1884","DOI":"10.1111\/add.14643","article-title":"Understanding and using time series analyses in addiction research.","volume":"114","author":"E Beard","year":"2019","journal-title":"Addiction."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"815-833","DOI":"10.1002\/sim.9645","article-title":"Cox models with time-varying covariates and partly-interval censoring-a maximum penalised likelihood approach.","volume":"42","author":"A Webb","year":"2023","journal-title":"Stat Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement.","volume":"12","author":"E Benchimol","year":"2015","journal-title":"PLoS Med."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"805-835","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational studies in Epidemiology (STROBE): explanation and elaboration.","volume":"18","author":"J Vandenbroucke","year":"2007","journal-title":"Epidemiology."}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:49:09Z","timestamp":1773150549000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":34,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.14044.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/hrbopenres.14044.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/hrbopenres.14044.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.15835.r54071","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.15533.r46662, Kristen A Morin, Northern Ontario School of Medicine University, Sudbury, Ontario, 16 Apr 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v2#referee-response-46662","order":0,"name":"referee-response-46662","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15533.r46663, Eugenia Oviedo-Joekes, The University of British Columbia, Vancouver, British Columbia, 30 May 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v2#referee-response-46663","order":1,"name":"referee-response-46663","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15533.r46753, Roman Ivasiy, Yale School of Medicine, New Haven, 28 May 2025, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-32\/v2#referee-response-46753","order":2,"name":"referee-response-46753","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Health Research Board (grant number SDAP-2023-029). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}