Providing patients with opioid use disorder (OUD) take-home methadone between five and 24 weeks after they complete induction (achieve a stable dose) appears to provide the greatest benefits in terms of treatment retention and mortality, according to a study published today in JAMA Internal Medicine.Why It’s Relevant
Due to safety concerns over potential misuse and overdose with methadone, patients must typically receive their daily treatment at a clinic, which can be inconvenient and potentially disruptive to retention. Since COVID-19, policies related to take-home methadone have become more relaxed, which data suggest is improving patient retention. But it’s not yet known if there is an ideal time to switch patients from onsite to take-home use.
By the Numbers
- Using health databases, researchers examined outcomes of more than 40,000 British Columbia residents who were eligible to receive take-home methadone between 2010 and 2022.
- Among 31,658 individuals with a history of opioid treatment, switching to take-home methadone at any time within the first 52 weeks after completing methadone induction resulted in modest reductions in treatment discontinuation and/or all-cause mortality after 78 weeks compared with no switching.
- The greatest benefits were seen between five and 24 weeks post-induction—with mortality decreasing from 9% to 8% and discontinuation from 66% to 60%.
- Switching to take-home methadone within the first four weeks reduced discontinuation by just 2%, while switching after 25 weeks produced no significant benefit on mortality.
What’s More
Take-home methadone was similarly effective at reducing treatment discontinuation among 9,788 adults who were initiating opioid therapy for the very first time. There was no noticeable effect on mortality, but the overall mortality rate was low in this first-time treatment group (0.34%).
The Other Side
This study relied on observational data where an individual’s eligibility for take-home methadone was based on clinician judgment and not specific health criteria. The data were also limited to one Canadian province and may not generalize to other locales.
Takeaway Message
These findings suggest that keeping patients on methadone under supervision for at least a few weeks to ensure they are clinically stable before providing take-home doses offers the best balance of patient safety and autonomy. As noted in an accompanying editorial, however, a rapid transition to take-home methadone could still be warranted depending on a patient’s specific circumstances.
Related Information
Source
Md. Belal Hossain, et al. Timing of initiation of methadone take-home dosing. JAMA Internal Medicine. Published September 8, 2026. doi:10.1001/jamainternmed.2026.3904
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