A new report based on death data from the Centers for Disease Control and Prevention (CDC) stopped short of saying that the liberalized take-home policies for methadone instituted in March 2020 were “safe,” but did say that the policy did not result in an increase in overdose deaths. The study, published July 13 as a research letter in JAMA Psychiatry, did not look at whether nonfatal overdoses or other harms resulted from the take-homes. Rather, the article, authored by researchers at the CDC and the National Institute on Drug Abuse (NIDA), showed that there were no deaths.
The March 2020 policy was instituted to reduce transmission of COVID-19 caused by patients congregating at clinics. The policy, from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA), allowed opioid treatment programs (OPTs) to dispense up to 14 days of take-home doses of methadone to unstable patients. It was up to the OTPs to determine how many doses to give to whom. (See https://atforum.com/2020/03/otp-regulations-loosened-due-to-pandemic/).
The study, “Methadone-Involved Overdose Deaths in the U.S. Before and After Federal Policy Changes Expanding Take-Home Methadone Doses From Opioid Treatment Programs,” is by Christopher M. Jones, PharmD, of the CDC and colleagues. Senior author is Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).
The researchers analyzed the CDC’s National Vital Statistics System for multiple causes of death, using 2019-2020 final data and 2021 provisional data.
After March 2020, overdose deaths not involving methadone continued to increase by about 69 deaths per month, whereas methadone-involved overdose deaths remained stable. The percentage of overdose deaths involving methadone declined at similar rates before and after the take-home policy change, with 4.5% of overdose deaths involving methadone in January 2019 and declining to 3.2% by August 2021.
Limitations of the study were:
- 5% of death certificates did not list specific drugs involved in the overdose;
- Provisional data for 2021 may minimally underestimate overdose deaths owing to delayed reporting; and
- OTP take-home policy changes occurred in the context of other policy changes and secular trends that could influence treatment and harms for people with opioid use disorder.
Still, the researchers urged that the findings “can inform decisions about permanently expanding take-home methadone.”