Relaxed Federal Methadone Take-home Policy Not Associated With Methadone-related Deaths

Strictly regulated methadone take-home dose policies at US opioid treatment programs have been critiqued for limiting access to flexible treatment, but they may also provide important protection against methadone-related overdose. The US COVID-19 emergency response included relaxation of these regulations. This research letter described changes in methadone-related and non-methadone-related overdose deaths in the US from January 2019 to August 2021.

• Interrupted time series analysis showed that overdose deaths not involving methadone increased by 78 deaths per month before March 2020, by 1078 deaths per month in March 2020, and by 69 deaths per month after March 2020.
• Methadone-related deaths per month were stable prior to March 2020; they increased by 94 deaths in March 2020, and remained stable after March 2020.
• The percentage of overdose deaths involving methadone declined 0.06 percent per month before March 2020, increased by 0.69 percent per month in March 2020, and declined 0.05 percent per month after March 2020.

Comments: This study documents a substantial increase in non-methadone-related overdose deaths at the beginning of the COVID-19 pandemic, and a modest increase in methadone-related deaths. Both before and after March 2020, non-methadone-related deaths rose significantly while methadone-related deaths did not. These data support continuation of the COVID-19 related federal take-home policy changes to improve access to methadone in the US.

Joseph Merrill, MD, MPH

References: Jones CM, Compton WM, Han B, et al. Methadone-involved overdose deaths in the US before and after federal policy changes expanding take-home methadone doses from opioid treatment programs. JAMA Psychiatry. 2022;79(9):932–934.