Acceptability of and Implementation Supports for Video Directly Observed Treatment to Enhance Methadone Dosing Flexibility in a Multisite Opioid Treatment Program: Qualitative Rapid Needs Assessment Study

Methadone is a first-line treatment for opioid use disorder, which is delivered in federally regulated opioid treatment programs (OTPs). Federal policies require directly observed dosing of methadone followed by graduated provision of nonobserved doses to take at home (ie, “take-home” dosing) after demonstrated stability is achieved. Policy changes since the COVID-19 pandemic have greatly expanded take-home dosing. Video directly observed treatment (video DOT) is an approach in which patients submit videos of themselves taking medications, which are asynchronously reviewed to verify adherence.