Video DOT Helps Opioid Use Disorder Patients Avoid the Stigma and Burden of In-person Care and Continue Methadone Treatment

A new qualitative study published in Addiction Science & Clinical Practice shows that our (as emocha Health) platform for video-based Directly Observed Therapy (VOT, VDOT, or video DOT) can help those suffering from opioid use disorder (OUD) avoid the challenges of getting continuous treatment by removing the timing requirements, travel burden, and stigma associated with in-person care.

For people with OUD, ensuring continuous methadone maintenance therapy can be critical to staying in recovery. But federal law restricts outpatient methadone treatment to Opioid Treatment Programs (OTPs), regulates medication dispensing, and requires daily, in-person monitoring for dosing until patients meet strict criteria for clinical stability.

During the COVID-19 public health emergency, the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed the number of medication take-home doses allowed to support required social distancing policies to protect patients and clinic staff. Video DOT arose as a way to ease concerns around safety and diversion and provide additional structure and supervision without the barrier of frequent attendance at an OTP. 

To understand the feasibility and accessibility of video DOT for methadone treatment, a team of researchers from the University of Washington School of Medicine research team launched a clinical pilot of video DOT among methadone treatment patients in three OTP sites in Washington State in 2020. Published in The Journal of Substance Abuse Treatment, the pilot study results suggest that technology-enabled remote observation of methadone doses, using our asynchronous video DOT platform can maintain and improve methadone adherence, reduce the barriers associated with in-person dosing requirements, and help address the behavioral health backlogs from the pandemic. 

The pilot proved video DOT is an effective treatment modality that can offer greater flexibility and patient-centeredness while retaining features that provide accountability and support correct methadone dosing for patient safety.

To better understand the experiences of the clinical pilot participants, the researchers interviewed 12 patients and three counselors for the qualitative study. They found that both patients and counselors were enthusiastic about video DOT, noting multiple benefits over traditional treatment experiences.

From their interviews, the study team found that our video DOT platform helped patients:

Reduce the burden of traveling to the clinic for treatment.

"It almost feels like a punishment coming in every day. There's not even a probation that's that intense, you know? It's just ridiculously intense. And almost unsustainable without assistance from somebody. For me, it's damn near impossible to come here every day. I managed to. But if I could've done [VOT] from the beginning, it would've made methadone treatment long-term a lot easier on me." – Patient 10.

Have more time to devote to other life priorities, including spending time with loved ones and maintaining consistent employment. 

‍“It did help not having to come in as often. . .that was the biggest thing, just not having to. Because, you know, have that time not to be with my kids and having to find something to watch them."– Patient 12

"[In-person daily dosing] really restricted what I [could get through] the temp service as far as jobs. Because they open at 5:30. So if you're not there at 5:30, those first 30 minutes is when they hand out all the jobs. So I'd have to come in for scraps after that . . . But yeah, when I got carries, it really made this place a lot more bearable." – Patient 9

Maintain an increased sense of autonomy, privacy, and normalcy.

". . . before, I was stressing, like okay, I only need to be on methadone X amount of years. I'm going to get straight, and I'm going to wean off, yadda, yadda because I don't want to be down there every day and all these other things. But now I'm like, okay, now it's a normal medication. Now I can take my medication in the morning and go about my day, just like with my antidepressants." – Patient 1.

“[VOT allows you to] just move on from having to go into the clinic and see the same people and see all the people using and stuff like that, and kind of get yourself out of that space and into other spaces. And it just gives you a more normal feeling, I guess. It makes you feel more of a normal part of society.” – Patient 5

‍Feel more connected with their counselors.

"I think, if anything, it kind of felt like I was giving [my counselor] a peek into my home life and stuff. Kind of more personal, more open. I wasn't super early in my sobriety, but it did also feel like, I don't want to say it helped keep me clean or anything. But it was definitely, like, oh my counselor's going to see this. I definitely don't want anything going on in the background that she wouldn't like… I think it just kind of made me, maybe, be more open. And it definitely made it feel more personal." – Patient 5.

Avoid a potentially triggering environment.

"It's the location itself [which] has become . . . kind of a hub for – well, there's people trying their best for recovery, and there's people that aren't. And there's people that are okay on their opiate side, but they're smoking crack or meth. There's always a ton of pitfalls. In the beginning, it didn't really bother me. But once I got clean, it started to bother me just being around a lot of people that weren't clean." – Patient 1.

‍Engage on an easy-to-use app.

"I didn't see anything that I think could be better. . . I was amazed at how easy it was to use it. It tells you exactly what to do, and there was only . . . two or three steps you had to do before you were taking your video and submitting it. . . So it was easy. It was great." – Patient 3

As SAMHSA, related federal agencies, and state opioid treatment authorities prepare to make the regulatory flexibilities for opioid treatment programs more permanent, OTPs must adopt new approaches to balance access and patient safety, our video DOT platform is an innovative and well-received solution.