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Heroin Addiction and Related Clinical Problems: 2025, 27, 19

Impact of Treatment Flexibilization Measures on Outcome Variables in Opioid Use Disorder Patients Receiving Methadone: Lessons Learned from the COVID-19 pandemic

Marta Narváez-Camargo, Oscar M. Lozano, Cinta Mancheño-Velasco, Fermin Fernández-Calderón, Ana De la Rosa Cáceres, and Carmen Díaz-Batanero

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-19

Summary: Background. The COVID-19 pandemic has led to the unforeseen implementation of more flexible treatment measures for opioid use disorder patients under methadone treatments, primarily through the use of telehealth services and more flexible medication dispensing protocols. Although previous results showed that these measures may have enhanced patient autonomy, facilitated access and favoured treatment flexibility, additional research is needed to assess flexibility measures’ benefits and optimise their integration into routine treatment, based on individual patient needs. Methods. Retrospective observational study based on data from the electronic health records (EHR) of 10,608 opioid use disorder outpatients under methadone treatment in Andalusia (Spain). The hybrid vs. in-person treatment modality, frequency of dosing evolution through the pandemic phases, and the characteristics of patients accessing those measures were examined. A hierarchical logistic regression model was performed to identify the impact of flexibilisation measures on treatment dropout vs retention among patients. Results. Hybrid attention rose from 12–15% pre-lockdown to 25% post-restrictions, reaching its peak during the first alarm state. Comorbid anxiety and personality disorders were mostly associated with a hybrid treatment modality. Dosing practices also shifted, with ~60% of patients on weekly schedules but increased use of +14 days dosing. Extended dosing was more common among employed or HIV-positive patients and those with less frequent prior substance use. Regression analysis indicated that hybrid care was significantly associated with reduced treatment dropout rates (OR = 0.85 [0.81 – 0.90]), with this effect further enhanced by an interaction with extended dosing; patients receiving both interventions exhibited the lowest proportion of discontinuation (0.22 vs 0.34 among all participants). Conclusions. Hybrid care may offer flexibility and accessibility, particularly in patients with more complex needs, such as those with comorbid mental health disorders. Combining this measure with longer dispensing schedules in indicated cases may further improve adherence to treatment in OUD patients.

Keywords: Opioid Use Disorder; Methadone treatment; COVID-19; telehealth; dispensing dosing; treatment retention; dropout.