Impacts of Disruptive Events on Addictive Behavioral Patterns: A Cross-Sectional Study of Methadone Maintenance Therapy During the COVID-19 Pandemic in Iran.

Background and Aims: The COVID-19 pandemic disrupted healthcare delivery and posed challenges for addiction treatment, particularly methadone maintenance therapy (MMT). This study examined changes in methadone use, behavioral patterns, and psychological well-being among MMT patients in Tehran, Iran, to assess how public health crises can influence addiction care. Methods: A retrospective cross-sectional study with within-subject pre-post comparisons was conducted among 180 MMT patients from four randomly selected treatment centers. Methadone intake and behavioral outcomes (smoking, physical activity, technology use, and anxiety) were assessed for the periods immediately before and during the pandemic. Multivariable logistic regression identified predictors of dose escalation. Results: Paired analyses (n = 179) showed a modest overall increase in mean methadone dose from 54.16 ± 37.28 mg to 62.09 ± 49.77 mg (mean change +7.93 mg; 95% CI, 2.49-13.37; p = 0.004). Subgroup analyses revealed heterogeneity: patients who increased intake (n = 57) rose by 35.79 mg (95% CI, 17.38-54.20; p < 0.001), while those who decreased intake (n = 14) reduced by 37.15 mg (95% CI, -65.73 to -8.57; p = 0.005). Regression analysis identified living with family (aOR = 2.72, p = 0.01) as a risk factor, while pre-existing illness (aOR = 0.09, p < 0.001) and age 40-50 years (aOR = 0.17, p = 0.02) were protective. Methadone formulation, timing, and frequency remained stable. Behaviorally, 21.1% reported stronger drug cravings, 14.4% reported slippage to other substances (most often methamphetamine), 94.4% were smokers with high nicotine dependence, 10% reported reduced physical activity, 44.4% increased mobile phone use, 39.4% increased internet use, and 28.3% experienced high anxiety. Conclusion: The pandemic was associated with increased methadone use and maladaptive behavioral changes among MMT patients, while dispensing practices remained resilient. Strengthening telehealth capacity, flexible dosing, integrated mental health services, and family-sensitive counseling will be essential to protect continuity of care during future disruptive events.