(27) Improving Methadone Access: Creating a Reliable Methadone Clinic Database in Los Angeles

Background & Introduction: Initially utilized to treat heroin addiction, methadone, a long-acting opioid agonist, has been used to treat OUDs since the mid-1900s in the United States (1). However, the current model of methadone treatment, where patients are required to receive their doses at specialized opioid treatment programs, only began to emerge during the Nixon administration with the Narcotic Addict Treatment Act of 1974 (2). Unequal access to programs disproportionately affects ethnic and racial minorities and lower-income patients (3).

Currently, methadone treatment plays an important role in the Los Angeles addiction treatment ecosystem, especially with the recent rise in fentanyl use (4). Great variability exists between each program’s intake and dosing hours, accepted insurances, and admissions requirements, information difficult to find online even using national searches like SAMHSA. This lack of readily available information hinders both patients’ and providers’ abilities to initiate methadone treatment, especially after discharge from hospitalizations (5).

To address these barriers to methadone treatment, our team developed an ongoing project to create a detailed, up-to-date database and map of methadone clinic information and intake requirements throughout Los Angeles. This project revealed several difficulties patients and providers may face when locating and contacting Opioid Treatment Programs (OTP) in this area.

Methods: To identify OTPs for our database, we utilized the Los Angeles County Service and Bed Availability Tool and startyourrecovery.org. We used the Google search term “methadone clinic los angeles” to locate clinics not listed on those two websites. Only outpatient OTPs within a 25-mile radius of Ronald Reagan UCLA Medical Center that administer methadone were included.

We contacted methadone clinics that met our requirements to gather their clinic intake hours, dosing hours, required forms of identification, maximum initial dosing limits, and policies regarding dosing of patients initially given methadone in the hospital. Answers were recorded on a datasheet.

A cleaned version of the datasheet was created to be more provider and patient-facing (https://docs.google.com/spreadsheets/d/1wB4RPshBuvZekYV6Wnh2JfawzcP2G30ITN6hge6Phb0/edit?usp=sharing). Furthermore, we coded an interactive map with the information we gathered using JavaScript and embedded it into a webpage using HTML (https://examplemethadonemap.weebly.com/). This map allows for the filtering of programs based on days open for intake. Additionally, we made printable map flyers so clinicians can give region-specific handouts on clinic information and directions for patients who may not have access to the internet (https://drive.google.com/file/d/10z0BZbZp8EXblFoDIFAaxvcGYPRCuRsg/view?usp=sharing).

Results: We identified twenty-six OTPs that met our inclusion requirements, based on the programs listed on the two websites utilized and our Google search. After calling each program, we determined that, despite being listed as open online, three were permanently closed (we confirmed this by using Google Maps street view to locate clinic signage), one was temporarily closed, and two were alternate names of two other clinics on our list. We were unable to speak to an employee at three programs despite leaving multiple voicemails, and one refused to answer our questions. In the end, we successfully received at least most of our requested information from sixteen clinics. For some clinics, the person who picked up was unable to answer medical questions, such as those about the maximum first dose of methadone administered.

Among these sixteen clinics, many different policies were in place. In terms of intake hours, eight clinics were open Monday to Friday, while the rest were open for varying combinations of weekdays, such as just Wednesday or Monday, Tuesday, and Wednesday. As for insurance, the OTPs we contacted demonstrated inconsistency between programs—while they all accepted Medi-Cal, others would not take certain private insurances or any private insurance. Programs also had dissimilar guidelines regarding the maximum first dose of methadone a patient could receive; this number ranged from no limit to 30 mg. Some OTPs also had unique procedures regarding this topic, including different maximum doses for different doctors, a required initial observational period before dispensation, and a mandatory trough test.

There were also broad similarities among programs. Fifteen OTPs were open from Monday to Friday for dosing; most of these programs opened at around 5:30 am and closed at around 1 pm. Fourteen OTPs were open on the weekend for dosing and most OTPs’ weekend hours were around 7 am-11 am. All programs required a state ID to receive methadone in the long term, though fourteen of them stated they would accept a hospital face sheet temporarily. Three programs expressed a willingness to help patients acquire needed IDs. Finally, fourteen clinics explicitly stated they would continue the methadone dosage a patient received in the ER or hospital. Already, providers in the ED are utilizing the map tool and handouts we created to help locate methadone clinics convenient to their patients.

Conclusion & Discussion: Methadone access in Los Angeles must be improved due to the significant barriers patients with OUD face. The limited intake and dosing hours of OTPs make it difficult for patients, like unhoused individuals or those with limited flexibility, to receive FDA-approved care for OUD.

Furthermore, the lack of an updated website that lists Los Angeles OTPs that dispense methadone may force providers and patients to spend a significant amount of time searching for programs and to rely on inaccurate information. This need for a centralized resource is further demonstrated by the significant variability in clinic hours, intake requirements, and dispensing protocols. Inconsistency can lead to delays in treatment, as patients may have to contact multiple clinics before finding one that fits their circumstances; such a prolonged process may also lead to patient burnout.

Further research should be conducted on how information access impacts methadone accessibility. Additionally, websites like findtreatment.gov should be transparent about when their databases have been checked and verified to make them as readable as possible. Lastly, projects like this should be undertaken in more major cities and communities to help streamline access to OUD care, better equipping the healthcare system to treat the current opioid crisis.

References: (1) Joseph, H., Stancliff, S., & Langrod, J. (2000). Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai journal of medicine, New York, 67(5-6), 347–364.

(2) Institute of Medicine (US) Committee on Federal Regulation of Methadone Treatment. (1995). Federal Regulation of Methadone Treatment (R. A. Rettig & A. Yarmolinsky, Eds.). National Academy Press.

(3) Bremer, W., Plaisance, K., Walker, D., Bonn, M., Love, J. S., Perrone, J., & Sarker, A. (2023). Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature. Frontiers in public health, 11, 1141093. https://doi.org/10.3389/fpubh.2023.1141093

(4) Shover, C. L., Falasinnu, T. O., Dwyer, C. L., Santos, N. B., Cunningham, N. J., Freedman, R. B., Vest, N. A., & Humphreys, K. (2020). Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance. Drug and alcohol dependence, 216, 108314. https://doi.org/10.1016/j.drugalcdep.2020.108314

(5) Calcaterra, S. L., Lockhart, S., Natvig, C., & Mikulich, S. (2023). Barriers to initiate buprenorphine and methadone for opioid use disorder treatment with postdischarge treatment linkage. Journal of hospital medicine, 18(10), 896–907. https://doi.org/10.1002/jhm.13193