A policy shift early in the pandemic from requiring people with opioid use disorder to report daily to clinics for methadone to sending stable patients home with a 28-day supply of the medication did not appear to lead to increased overdose deaths involving methadone relative to overdose deaths involving other substances, suggests a report published in JAMA Psychiatry. Rather, the percentage of overdose deaths involving methadone fell after March 2020, while overdose deaths that did not involve methadone continued to rise.
“Treatment is an essential tool to stop the addiction and overdose crises, but it is vastly underused,” said National Institute on Drug Abuse Director Nora Volkow, M.D., senior author of the study, in a news release. “This evidence adds significant weight to the argument that effective treatment for substance use disorders should be offered in an accessible and practical way that works for people who need it.”
Historically, people being treated with methadone for opioid use disorder in the United States could access this treatment only at federally certified opioid treatment programs (OTP), where most are required to make daily visits to receive the medication—a barrier for people trying to balance work, child care, and other needs, the release noted. On March 16, 2020, in an effort “to provide increased flexibility,” the Substance Abuse and Mental Health Services Administration (SAMHSA) alerted states that they could “request blanket exceptions for all stable patients in an OTP to receive 28 days of take-home doses of the patient’s medication for opioid use disorder.” The guidance also allowed patients identified by the OTP as “less stable” to receive up to 14 days of take-home medication.
For the current study, Volkow, Christopher M. Jones, Pharm.D., Dr.P.H., of the Centers for Disease Control and Prevention (CDC), and colleagues analyzed monthly drug overdose deaths that took place from January 2019 to August 2021, as recorded in the CDC’s National Vital Statistics System.
“After March 2020, overdose deaths not involving methadone continued to increase [by] approximately 69 deaths per month, whereas methadone-involved overdose deaths remained stable,” the authors wrote. The percentage of overall overdose deaths involving methadone fell from 4.5% of overdose deaths in January 2019 to 3.2% by August 2021, they added.
“Coupled with research demonstrating improved patient satisfaction, treatment access, and engagement from these policies, these findings can inform decisions about permanently expanding take-home methadone,” the authors concluded.
For related information, see the Psychiatric News articles “Pandemic Creates Challenges, New Opportunities for Treating Patients With Substance Use Disorder” and “Discrimination Persistent Barrier to Care for OUD Patients.”
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