JMIR Publications

ABSTRACT

Background:

Methadone is a first line treatment for opioid use disorder (OUD), which is delivered in federally-regulated opioid treatment programs (OTPs). Federal policies require directly observed dosing of methadone followed by graduated provision of non-observed doses to take at home (“take-home” dosing) after demonstrated stability is achieved. Policy changes since the COVID-19 pandemic have greatly expanded “take-home” dosing. Video directly-observed treatment (video DOT) is an approach where patients submit videos of themselves taking medications, which are asynchronously reviewed to verify adherence.

Objective:

In preparation for an implementation trial evaluating adoption of video DOT in OTP settings, we conducted a rapid needs assessment with multidisciplinary stakeholders to assess acceptability, perceived benefit, and needed support for video DOT to monitor take-home methadone dosing.

Methods:

In our rapid needs assessment, we explored perspectives of multidisciplinary stakeholders (n=20) at three clinical sites within a single OTP in western Washington state. Trained qualitative researchers took ethnographic fieldnotes at meetings (n=2) with organizational leadership and in-person site visits (n=3) with clinical and administrative staff. Fieldnotes were analyzed via a team-based Rapid Assessment Process using coding templates informed by the Consolidated Framework for Implementation Research (CFIR). Summaries of qualitative data were iteratively reviewed by the study team and further confirmed with site stakeholders.

Results:

Stakeholders included leadership (n=6), medical providers (n=4), substance use disorder counselors (n=7), and clinic managers and support staff (n=3). Stakeholders perceived that video DOT could lessen the barriers patients face, including travel burden (e.g., time, cost) and stigma. They also identified that video DOT could have important impacts on early care retention given expansions of take-home dosing. However, stakeholders anticipated added burden for clinical staff and emphasized the need for implementation supports that would limit burden, such as additional staff support for video submission review and clear communication pathways for when video submissions require additional clinical input.

Conclusions:

A rapid needs assessment of OTP sites for a future implementation study suggested that stakeholders saw potential benefits for patients with video DOT, but there were concerns that this would add to their work burden. Learnings informed the subsequent tailoring of clinical use cases and implementation supports.