Abstract / Summary
Importance Patients often experience travel-related barriers to methadone dosing at opioid treatment programs (OTPs), but the nature of their experiences are not well understood. Objective To characterize patient experiences with travel to OTPs for regular methadone dosing visits at a large multisite OTP in Washington state. Design, Setting, and Participants This qualitative study utilized an embedded mixed-methods design. Our sample included patients currently receiving methadone treatment at 2 OTP sites in Washington state from November 2024 to February 2026 (including mobile units that operated as extension of the sites). Data were analyzed between February and July 2026. Exposures Experiences of travel to OTPs for regular, in-person observed methadone dosing. Main Outcomes and Measures Results of a survey administered to patients regarding the modality, time, and cost (eg, gas, childcare) of traveling to the OTP. A subsample of surveyed patients were interviewed about their experiences with and perspectives on traveling for dosing visits. Survey data were analyzed descriptively. Interviews were coded using rapid assessment process. Results Our sample included 98 survey participants and 16 qualitative interview participants (median [IQR] age, 43.0 [38.8-50.3] years; 8 cisgender women [50.0%]). Among survey respondents, 54 (55.1%) drove themselves to the OTP, 21 (21.4%) were driven by another person, 12 (12.3%) took public transportation, and 6 (6.1%) took insurer-sponsored medical transportation; 18 (18.4%) reported a disabling condition and 16 (16.2%) needed an assistive device for walking. Participants spent a mean (range) 82.5 (10.0-330.0) minutes round trip and $15.80 ($0-$200.00) in travel-related costs for each visit. Qualitative interviews illuminated that, while distance was often a barrier, unpredictable OTP wait times or conflicts with work, medical, or family obligations also mattered considerably. Participants shared that dosing visits directly prohibited their ability to work, but missing visits put participants at risk for return to opioid use and treatment stagnation. Conclusions and Relevance In this mixed-methods qualitative study, requiring regular visits for in-person observed methadone dosing presented significant structural barriers that affect patients’ treatment experience, adherence, and lives. Increasing the flexibility and accessibility of methadone treatment—through policies and novel care practices that actively seek to minimize burden of travel to the OTP and destigmatize care—is essential to enhance care quality and equity.