Methadone dose, take home status, and hospital admission among methadone maintenance patients.
OBJECTIVE
Among patients receiving methadone maintenance treatment (MMT) for opioid dependence, receipt of unobserved dosing privileges (take homes) and adequate doses (ie, ≥ 80 mg) are each associated with improved addiction treatment outcomes, but the association with acute care hospitalization is unknown. We studied whether take-home dosing and adequate doses (ie, ≥80 mg) were associated with decreased hospital admission among patients in an MMT.


METHODS
We reviewed daily electronic medical records of patients enrolled in one MMT program to determine receipt of take-home doses, methadone dose 80 mg or more, and hospital admission date. Nonlinear mixed-effects logistic regression models were used to evaluate whether take-home doses or dose 80 mg or more on a given day were associated with hospital admission on the subsequent day. Covariates in adjusted models included age, sex, race/ethnicity, human immunodeficiency virus status, medical illness, mental illness, and polysubstance use at program admission.


RESULTS
Subjects (n = 138) had the following characteristics: mean age 43 years; 52% female; 17% human immunodeficiency virus-infected; 32% medical illness; 40% mental illness; and 52% polysubstance use. During a mean follow-up of 20 months, 42 patients (30%) accounted for 80 hospitalizations. Receipt of take homes was associated with significantly lower odds of a hospital admission (adjusted odds ratio [AOR] = 0.26; 95% confidence interval [CI], 0.11-0.62), whereas methadone dose 80 mg or more was not (AOR = 1.01; 95% CI, 0.56-1.83).


CONCLUSIONS
Among MMT patients, receipt of take homes, but not dose of methadone, was associated with decreased hospital admission. Take-home status may reflect not only patients' improved addiction outcomes but also reduced health care utilization.
Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA. awalley@bu.edu
Alexander Y
AY
Walley
Debbie M
DM
Cheng
Courtney E
CE
Pierce
Clara
C
Chen
Tiffany
T
Filippell
Jeffrey H
JH
Samet
Daniel P
DP
Alford
D000328:Adult; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012646:Self Administration
D009294:Narcotics; D008691:Methadone