Patient Travel Experiences for Methadone Dosing Visits
5 affiliations
- 1Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle
- 2Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- 3Evergreen Treatment Services, Seattle, Washington
- 4Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
- 5Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
Abstract
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.
Related
- NASSJ commentary: patient travel burden and postoperative outcomes after lumbar fusion.
- Patient Perceptions of Medicare Annual Wellness Visits: Findings From a Pilot Survey
- Billing E-Visits and Patient Medical Advice Requests in a Large Academic Health Center
- Communication Skills Training Using Simulation for Integrating Adverse Childhood Experiences into Adult Primary Care Visits for Students
- Human Adenovirus B55 Infection in Patient without Recent Travel History, France
BibTeX
@article{austin2026patient,
title = {{Patient Travel Experiences for Methadone Dosing Visits}},
author = {Elizabeth J. Austin and Varuna Ravi and Alexander J. Gojic and Elenore P. Bhatraju and James Darnton and Paul Grekin and Sean Soth and Steve Woolworth and Kevin A. Hallgren and Judith I. Tsui and Emily C. Williams},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.37601},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854876},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patient Travel Experiences for Methadone Dosing Visits
AU - Elizabeth J. Austin
AU - Varuna Ravi
AU - Alexander J. Gojic
AU - Elenore P. Bhatraju
AU - James Darnton
AU - Paul Grekin
AU - Sean Soth
AU - Steve Woolworth
AU - Kevin A. Hallgren
AU - Judith I. Tsui
AU - Emily C. Williams
PY - 2026
DA - 2026/10/06
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.37601
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854876
AB - 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.
SN - 2574-3805
ER -