Rate of overdose deaths before and after the take-home methadone policy

During the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration allowed exceptions to be requested by states to allow people receiving methadone treatment to take home 28- and 14-day doses.

General administration of methadone is given daily in opioid treatment programs. It has been reported that most methadone-related overdose deaths result from the use of methadone for pain, not necessarily for the treatment of opioid use disorder (OUD).

The investigators aimed to assess the relationship between these exceptions and methadone-related overdose deaths and to determine whether fatal overdoses had 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 used data from the US National Vital Statistics System CDC Multiple Causes of Death 2019-2020 Final, and 2021 Interim Reports.

Percentages of overdose deaths involving methadone between January 2019 and August 2021 were calculated, along with monthly drug overdose deaths with and without methadone involvement. Changes in outcomes before and after the March 2020 take-home methadone policy were assessed using interrupted time series analyzes (ITSAs).

Interrupted Time Series Analysis Estimates

Monthly overdose deaths without methadone involvement increased by 78.12 (95% CI, 53.69-102.55; PP= 0.003). And then 69.07 (95% CI, 15.45-122.70; P= 0.01) deaths per month after March 2020, as estimated by ITSA.

Similar trend slopes were observed before and after March 2020 (−9.05 [95% CI, −67.98 to 49.88]; P= 0.76).

For overdose deaths involving methadone, results showed a decline of 0.06% (95% CI, -0.10% to 0.01%; P= 0.02) per month before March 2020, and an increase of 0.69% (95% CI, 0.22% to 1.15%; P= 0.006) in March 2020. Rates decreased after March 2020 by 0.05% per month (95% CI, −0.08% to 0.02%; P= 0.001).

The trend slopes were similar before and after March 2020 (0.01% [95% CI, −0.05% to 0.06%]; P= 0.82).

Take-home methadone support

“The results provide information on methadone-related overdose deaths during COVID-19. In March 2020, overdose deaths with and without methadone increased. After March 2020, non-methadone overdose deaths continued to increase by approximately 69 deaths per month, while methadone-related overdose deaths remained stable,” the investigators reported.

The study said these data, together with findings indicating that the take-home methadone policy improved patient satisfaction, access to treatment and commitment to these policies, can inform decisions about permanent expansion. take-out policy.

Limitations were acknowledged as interim data for 2021 may have barely underestimated overdose deaths due to a delay in reporting, investigators say. About 5% of death certificates did not detail the specific drugs involved in the overdose. Additionally, they noted that Opioid Treatment Program (OTP) policy changes accompanied other policy changes and secular trends that could potentially be influential.

“These findings suggest that the modest increase in methadone-related overdose deaths in March 2020 was associated with the surge in general drug overdose deaths caused by illicitly manufactured fentanyl during the early months of the COVID-19 pandemic. rather than associated with the take-out OTP 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.

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