Improving Methadone Patient-Centered Treatment (IMPaCT) to Enhance Retention in Care

About This Grant

PROJECT SUMMARY/ABSTRACT Opioid overdose deaths remain at alarming levels, driven largely by illicitly manufactured fentanyl. Methadone is a highly effective medication for opioid use disorder (OUD) that reduces mortality by nearly 50%. Despite its demonstrated effectiveness, methadone's impact on OUD-related morbidity and mortality remains limited due to low treatment initiation and retention rates. Historical regulations have restricted methadone treatment to opioid treatment programs (OTPs) that are characterized by highly protocolized clinical workflows that limit patient- centered care. In February 2024, federal methadone regulations were updated for the first time in decades. The new regulations authorized greater flexibility in methadone treatment to promote patient-centered care, including decreased requirements for daily in-person dosing (increasing take-home doses), greater clinical discretion around initial dose strength, and more individualized treatment planning (optional counseling). The new regulations are a major departure from current OTP practices and there is a dearth of research on how to implement these changes into clinical practice to improve the adoption and impact of patient-centered methadone treatment. Through the proposed training and research in this K23 application, Dr. Christine will acquire crucial skills to achieve his career goal of becoming an expert clinician-investigator focused on comprehensively evaluating and implementing health policies to improve the health of people with OUD. With guidance from an experienced mentor team, Dr. Christine will combine training in qualitative and mixed methods research, partner-engaged implementation science, and trial design and evaluation to develop and pilot test the Improving Methadone Patient Centered Treatment (IMPaCT) implementation program. The goal of the IMPaCT program is to increase OTP adoption of patient-centered methadone practices to improve retention in treatment. This proposal will address the following aims: 1) Identify contextual factors that influence the adoption of patient- centered methadone practices through interviews with Colorado OTP clinicians, patients, and state regulators; 2) Partner with patients and clinicians from two distinct Denver OTPs to develop the IMPaCT implementation program designed to modify clinical workflows and tailor implementation strategies to increase the adoption of patient-centered methadone care; 3) Assess the feasibility, implementation-related outcomes, and preliminary effectiveness of the IMPaCT program in a 3-month pilot trial at two distinct Denver OTPs. The trial will use patient and clinician interviews and surveys paired with electronic health record data to assess the feasibility of a future larger trial. It will also assess adoption, implementation and reach of the IMPaCT program, and preliminary effectiveness on 90-day treatment retention. The overarching goal of this proposal is to give Dr. Christine the training necessary to help bridge the addiction policy-to-clinical practice divide. The findings from the proposal will inform an R01 application to test the IMPaCT bundle in a large, randomized trial with the goal of enhancing patient-centered methadone treatment, improving treatment retention, and reducing opioid overdose deaths.