Overdose Death Rates Before and After Take-Home Methadone Policy

Christopher M. Jones, PharmD, DrPh, MPH

During the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration permitted exceptions to be requested by states in order to allow individuals receiving methadone treatment to take home 28 and 14 days worth of doses.

The general administration of methadone is given on a daily basis in opioid treatment programs. It’s been indicated that most methadone-involved overdose deaths result from methadone use for pain, not necessarily opioid use disorder (OUD) treatment.

Investigators aimed to evaluate the relationship between these exceptions and methadone-involved overdose deaths and determine if fatal overdoses increased during this time.

CDC Vital Statistics

Christopher M. Jones, PharmD, DrPH, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), and a team of investigators utilized data from the US CDC National Vital Statistics System multiple cause of death 2019-2020 final, and 2021 provisional reports.

Percentages of overdose deaths involving methadone during January 2019-August 2021 were calculated, as well as the monthly drug overdose deaths with and without methadone involvement. Changes in outcomes before and after the March 2020 methadone take-home policy were assessed with interrupted time series analyses (ITSA).

Interrupted Time Series Analysis Estimations

Monthly overdose deaths without methadone involvement increased by 78.12 (95% CI, 53.69-102.55; P < .001) deaths per month prior to March 2020. In March 2020, these deaths increased by 1078.27 (95% CI, 410.08-1746.46; P = .003). And then, by 69.07 (95% CI, 15.45-122.70; P = .01) deaths per month after March 2020, according to ITSA-estimation.

Similar trend slopes were observed before and after March 2020 (−9.05 [95% CI, −67.98 to 49.88]; P = .76).

As for overdose deaths involving methadone, results showed a decline of 0.06% (95% CI, −0.10% to 0.01%; P = .02) per month before March 2020, and an increase of 0.69% (95% CI, 0.22%-1.15%; P = .006) in March 2020. The rates declined after March 2020 0.05% per month (95% CI, −0.08% to 0.02%; P = .001).

Trend slopes were similar before and after March 2020 (0.01% [95% CI, −0.05% to 0.06%]; P = .82).

Support for Take-Home Methadone

“Findings provide insights about methadone-involved overdose deaths during COVID-19. In March 2020, overdose deaths both with and without methadone increased. After March 2020, overdose deaths not involving methadone continued to increase approximately 69 deaths per month, whereas methadone-involved overdose deaths remained stable,” investigators reported.

The study stated that these data paired with results indicating the take-home methadone policy has improved patient satisfaction, treatment access, and engagement from these policies, can inform decisions about permanent expansion of the take-home policy.

Limitations were acknowledged as the provisional data for 2021 may have minimally underestimated overdose death owing to delayed reporting, according to investigators. Approximately 5% of death certificates did not detail specific drugs involved in the overdose. Additionally, they noted that the Opioid Treatment Program (OTP) policy changes accompanied other policy changes and secular trends that could potentially have an influence.

“These findings suggest the modest increase in methadone-involved overdose deaths in March 2020 was associated with the spike in overall drug overdose deaths driven by illicitly made fentanyl in the early months of the COVID-19 pandemic rather than associated with OTP take-home policy changes,” they concluded.

The study, “Methadone-Involved Overdose Deaths in the US Before and After Federal Policy Changes Expanding Take-Home Methadone Doses From Opioid Treatment Programs” was published in Jama Psychiatry.