Intervention
Barriers and facilitators (sometimes called "contextual determinants") are factors that make it harder or easier to implement methadone. These factors span multiple levels. Click the buttons on the left to read more about common barriers and facilitators for methadone. In addition, view the RASC guides on Contextual Determinants Affecting Implementation and the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) to learn practical ways to assess these constructs.
For methadone treatment for opioid use disorder, barriers and facilitators in the intervention domain often relate to the way in which the medication works in the body to produce its intended effect.
Barriers
Methadone is a long-acting medication that provides full opioid effects. As a result, there is a higher risk of overdose for methadone compared to other medications for opioid use disorder, such as buprenorphine. It can also take longer to find the right dose for a given individual, given that changes to dosing must be made incrementally. Methadone can also interact with other medications and require more frequent medical monitoring.
Methadone must be dispensed daily from an opioid treatment program, especially in the initial period when an individual starts methadone. This creates a great burden on providers and persons with opioid use disorder. The daily dosing requirement also creates a very narrow time window for follow-up care linkage after individuals are initiated on methadone from non-traditional settings, such as during a hospitalization.
Facilitators
Methadone is a long-acting medication that provides full opioid effects. As a result, individuals with a higher tolerance for opioids might prefer methadone over other medications for opioid use disorder, such as buprenorphine. Additionally, starting methadone for the first time (or re-starting methadone after a pause in treatment) does not carry a risk of precipitating withdrawal symptoms as buprenorphine does.