Timing of Initiation of Methadone Take-Home Dosing.

Initiating methadone take-home dosing 5–12 weeks after induction completion in British Columbia is linked to the largest 78-week reductions in all-cause mortality and methadone discontinuation versus no take-home dosing.

• Why it matters: Daily witnessed ingestion is standard in community pharmacies, but it is unclear whether delaying take-home dosing could hinder retention and the lifesaving effects of methadone maintenance.
• What they did: Using target trial emulation of observational data from British Columbia (2010–2022), the study compared no take-home dosing with initiation at 0–4, 5–12, 13–24, and 25–52 weeks after induction, estimating 78-week adjusted risk differences.
• The result: In prevalent new users, mortality ARDs were -0.98 (95% CI, -1.62 to -0.33) for 5–12 weeks and -5.29 (95% CI, -6.82 to -3.76) for discontinuation; similar patterns appeared in incident users and sensitivity analyses.

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