Brian Chan1, Kim A Hoffman2, Christina Bougatsos3, Sara Grusing3, Roger Chou3, Dennis McCarty4. 1. Department of General Internal Medicine, OHSU Medical School, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. 2. OHSU-PSU School of Public Health, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. 3. Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. 4. OHSU-PSU School of Public Health, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. Electronic address: mccartyd@ohsu.edu.
Abstract
BACKGROUND: The Drug Enforcement Administration (DEA) approved the first mobile medication unit (i.e., a van to administer methadone) in 1988 and approved units on an ad hoc basis until issuing a moratorium in 2007 citing concerns about safety and diversion. In February 2020, the DEA released a notice of proposed rulemaking to permit a resumption of mobile medication units. The Biden Administration plans to release the final rule in 2021. Because a preliminary scan suggested limited evidence, a scoping review examined the research related to methadone vans to identify and assess the extent of mobile methadone research and inform the development and implementation of new mobile services. METHODS: A scoping review, supplemented with key informant interviews, identified and described the most relevant evidence. Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to July 2020. RESULTS: Informant interviews provided perspective on the need for and the use of mobile medication units, the history of methadone vans, and benefits and problems associated with the units. The scoping review found limited evidence: three cohort analyses (one prospective) and one before and after analysis (four studies) of individuals using mobile medication services. Mobile services were associated with enhanced retention in care (relative to patients in fixed site programs) and mobile units appeared to facilitate access for underserved populations with opioid use disorders. DISCUSSION: The key informants addressed the history of methadone vans, the potential use to serve rural communities and correctional facilities and the benefits and problems associated with mobile services. The scoping review found evidence that mobile services increase methadone access among underserved populations and may enhance retention in care. The DEA's proposed regulatory modification creates opportunities to further evaluate the implementation and the effects of mobile medication units.
BACKGROUND: The Drug Enforcement Administration (DEA) approved the first mobile medication unit (i.e., a van to administer methadone) in 1988 and approved units on an ad hoc basis until issuing a moratorium in 2007 citing concerns about safety and diversion. In February 2020, the DEA released a notice of proposed rulemaking to permit a resumption of mobile medication units. The Biden Administration plans to release the final rule in 2021. Because a preliminary scan suggested limited evidence, a scoping review examined the research related to methadone vans to identify and assess the extent of mobile methadone research and inform the development and implementation of new mobile services. METHODS: A scoping review, supplemented with key informant interviews, identified and described the most relevant evidence. Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to July 2020. RESULTS: Informant interviews provided perspective on the need for and the use of mobile medication units, the history of methadone vans, and benefits and problems associated with the units. The scoping review found limited evidence: three cohort analyses (one prospective) and one before and after analysis (four studies) of individuals using mobile medication services. Mobile services were associated with enhanced retention in care (relative to patients in fixed site programs) and mobile units appeared to facilitate access for underserved populations with opioid use disorders. DISCUSSION: The key informants addressed the history of methadone vans, the potential use to serve rural communities and correctional facilities and the benefits and problems associated with mobile services. The scoping review found evidence that mobile services increase methadone access among underserved populations and may enhance retention in care. The DEA's proposed regulatory modification creates opportunities to further evaluate the implementation and the effects of mobile medication units.
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