Background
Methods
Study design
Participants and setting
Procedures
Analysis
Results
Participant characteristics
Demographics | Number (%) n = 46 |
---|---|
Mean Age (in years) (SD) | 44.1 (12.5) |
Gender | |
Woman | 23 (50%) |
Man | 23 (50%) |
Ethnicity and race (select all that apply) | |
Caucasian/White | 44 (96%) |
Hispanic or Latinx | 2 (4%) |
American Indian/Alaska Native | 6 (13%) |
Take home methadone doses | |
1 dose every week | 17 (37%) |
2–6 doses every week | 11 (24%) |
13 doses every 2 weeks | 9 (19.5%) |
27 doses every month | 9 (19.5%) |
Education | |
Less than high school graduation | 9 (19.5%) |
High school graduate/GED | 16 (34%) |
Some college | 14 (30%) |
Associate’s degree/Bachelor’s degree/trade school | 7 (15%) |
Employment status | |
Employed | 12 (26%) |
Unemployed/Looking for work | 20 (43%) |
Retired | 2 (4%) |
Disability | 11 (24%) |
Other (odd jobs/seasonal/temp work) | 1 (2%) |
Relationship Status | |
Married | 4 (9%) |
Widowed | 3 (6%) |
Divorced/Separated | 6 (13%) |
Never Married/Single | 20 (43%) |
Living with Partner/Partnered | 13 (28%) |
Homeless in the past 6 months | |
Yes | 3 (7%) |
No | 43 (93%) |
Insurance (select all that apply) | |
Medicaid (Oregon Health Plan) | 41 (89%) |
Medicare | 5 (11%) |
Employer-based | 3 (7%) |
Health Insurance for Tribal Community Members | 1 (2%) |
Opioid use other than methadone in the past 30 days | |
Yes, non-prescribed | 4 (9%) |
Yes, prescribed | 1 (2%) |
No | 41 (89%) |
Benzodiazepine use in the past 30 days | |
Yes, non-prescribed | 1 (2%) |
Yes, prescribed | 2 (5%) |
No | 43 (93%) |
Methamphetamine use in the past 30 days | |
Yes | 3 (7%) |
No | 43 (93%) |
Alcohol use in the past 30 days | |
Yes | 5 (11%) |
No | 41 (89%) |
Adapting to changing OTP policies throughout the pandemic
Rapid implementation of early policies
…One day it was like boom. Everything changed. They kind of worked us up into things might be changing a little bit…giving you the heads up that this COVID thing is getting kind of serious, but they didn't over-react. They didn't panic… They were just really afraid that this COVID was going to take us all out, you know? – [53-year-old woman, P4]
Sometimes you don't want to wear a mask, it's suffocating…[but] It's just part of what's going on. If we want to be safe and not catch it, then that's it. I don't want to give nothing to nobody and I don't want to catch nothing. So I'll go with the program…do what I got to do, just to keep safe. [48-year-old man, P2]
Settling into OTP policy changes and new requirements
Now everybody is kind of used to it…secondary motions now—are everyday things. It’s like everybody wearing a mask, it’s like [at the beginning], ‘haha what are you doing?’ and now everybody wears them. It’s just natural now. – [53-year-old woman, P4]
…When it first happened, it had us all on edge, but I think that as time goes by and…our daily life adapts to it, I think that we just have a healthy respectful fear of [COVID-19], but we have learned to deal with it. – [41-year-old man, P12]
Rolling back of COVID-19-related increased take-home doses
I don’t like [going from one month to 2 weeks] at all but, honestly, you don’t rattle the cage too much…I feel kind of put upon in a way because…I shouldn’t be in there with all the people. I am staying away from the grocery stores and everything but my methadone—of course. Anyway, I am not happy, but I’m not mad either. Just disappointed …They said COVID was over basically, I think COVID’s worse than ever. – [64-year-old woman, P19]
Well, personally I think they should have stayed on getting us more take outs… not very long ago they switched back to every day and it seems like the people that were doing good … it seems like they would stay with that because the outbreak isn’t over by any means. – [27-year-old man, P21]
Recognizing benefits, and occasional struggles, with take-home methadone dosing
I really don’t have a challenging part. I thought it went very easy. When I took one I saved the bottle, when I take the next one I save the bottle and I bring those back show them to the nurses…So I wouldn’t even really say there was any difficult or frustrating parts to it to be quite honest.” [27-year-old man, P22]
Enhanced self-esteem and feelings of normalcy
I didn’t feel nervous… that I would take them all at once or have trouble taking them every day. I didn’t feel like I wasn’t being monitored properly because I wasn’t coming into the clinic all the time…When you get your take-homes it’s like you feel you are being trusted to take care of yourself, and do the right thing…it felt great…that I was on the right track in my recovery. – [39-year-old woman, P29]
[I am] able to live a normal life without having to come in every single day. I have a baby at home and stuff so that’s initially why I joined the clinic…Not having to come in. I feel a little more independent. I feel when I do get a job it will be a lot easier…I just enjoy being able to be more like a normal person, just having my medication at home. [31-year-old woman, P15]
Reinforcing and supportive of recovery
I get all these take-homes and then soon in 53 days, I will get a month worth of take-homes. I will only have to come in once a month and that will be great…I don’t have to stop what I am doing to come in to dose. And it also helps me with my recovery just to get these benefits of take-homes…It makes me feel proud of myself. – [39-year-old woman, P9]
Unfortunately, the people who come here…my old people [are] the people you try—necessarily to not spend that much time with anymore…I like to try to stay away as much as possible. I’d rather not see a lot of them if I don’t have to…Especially since I have been doing good for a while, kind of earned it anyways so I felt safe from my sobriety. It worked out good. – [38-year-old man, P35]
Reclaiming time spent traveling doing other rewarding activities
I was able to go camping with my mom and not have to worry about asking for extra doses. I went and saw my son and I didn't have to ask for extra doses 'cause I already had them. Just made it a little easier. A lot easier. – [51-year-old woman, P18]
It gives me a little break. [I can do] other things, like going to the river. I went and floated this weekend, and just hanging out with dad and barbecuing and doing yard work and stuff like that. – [48-year-old man, P2]
I am a single mom and…especially now that I am back to work, it is nice and convenient for me because I have to be to work at a certain time and it's hard for me to guarantee that I can get in [to the OTP] as often…it's definitely made it easier. – [33-year-old woman, P11]
Struggles with take-home methadone
Now, I like coming in everyday because I think it keeps you on track…I think it's better for people at first…I wasn't even getting take-homes, and all of a sudden here I am getting two weeks of my medicine so it was kind of a lot…For me it just wasn't good at the time because I was still pretty new in my sobriety, you have to trust in yourself and everybody is different. – [44-year-old woman, P25]
Continuing policies and procedures post-pandemic
COVID-19 protocols could prevent spreading other infections
I think that they still should have the glass shields…I mean, [it’s] not just COVID, you can still get the flu from people. For somebody like me, getting the common cold can be-- that's what I went to the hospital for, my grandson gave me the rhinovirus which is the common cold. So, it's not just COVID. – [49-year-old woman, P44]
The fact that it's limited amount of people, not so crowded in here, you know? So I feel a lot more comfortable sitting in here waiting when it's not as many people and for the fact of not spreading any diseases or colds. – [29-year-old woman, P20]
Social distancing created a more supportive environment for recovery and mental health.
I like how it's not as crowded…That's nice because when there [are] too many people in the waiting room, it triggers anxiety and it does a lot on the head. PTSD sort of type thing when everybody gets loud…So now…it's usually pretty quiet and not hectic. – [29-year-old man, P16]
[I would continue] the social distancing, just making sure that there's not a lot of people in the waiting areas. It gets crowded and people are standing and people that don't get along here so it causes more problems… [this is] a small, community… a lot of people know a lot of people -- some people that go here that are still in the addiction…you always see someone that you know or that you have a problem with. So a lot of fights seem to happen. – [31-year-old woman, P3]
Desiring of more tailored, individualized OTP services
I would like to see is maybe not having to come in quite as often…Everybody is different. Everybody should be looked at on an individual basis…maybe the people who make their appointments, the people who are making an effort to make a change, and that are certainly trying to utilize the program…I would hope for…less having to come in just to dose. I don't mind taking seven days at a time. I was okay with the Monday, Wednesday and Friday. I thought that was very fair because I was still able to have contact with counselors…even if I didn't have an appointment. – [27-year-old man, P22]