Overdose deaths during pandemic driven by fentanyl, not policy changes
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An increase of methadone-involved overdose deaths beginning in March 2020 was linked to a rise in overdose deaths from illicitly made fentanyl, not policy changes for take-home methadone, data show.
On March 16, 2020, the Substance Abuse and Mental Health Services Administration allowed states to request blanket exceptions to provide up to 14- and 28-day take-home methadone treatments for those in opioid treatment programs whose access was affected by the COVID-19 pandemic
“This signaled a shift in practice because most patients historically receive methadone daily from [opioid treatment programs],” Christopher M. Jones, PharmD, DrPH, MPH, the acting director of the CDC’s National Center for Injury Prevention and Control, and colleagues wrote in a research letter in JAMA Psychiatry.
Jones and colleagues used data from the CDC’s National Vital Statistics System to assess causes of deaths among Americans in 2019, 2020 and 2021. Monthly drug overdose deaths with and without involving methadone were calculated from January 2019 to August 2021.
According to the authors, estimated monthly overdose deaths without involving methadone increased by 78.12 before March 2020 (95% CI, 53.69-102.55), by 1,078.27 deaths in March 2020 (95% CI, 410.08-1,746.46) and by 69.07 deaths per month after March 2020 (95% CI, 15.45-122.70).
Monthly overdose deaths involving methadone were stable before March 2020 (–0.12; 95% CI, –2.54 to 2.29). During March 2020, overdose deaths involving methadone were consistent with increases when compared with those not involving methadone and increased by 94.12 per month (95% CI, 45.38-142.86). After March 2020, monthly overdose deaths remained stable (–1.91; 95% CI, –5.50 to 1.68).
Estimated percentages of overdose deaths involving methadone declined by 0.06% per month before March 2020 (95% CI, –0.10% to 0.01%), increased by 0.69% in March 2020 (95% CI, 0.22%-1.15%), and declined 0.05% per month after March 2020 (95% CI, –0.08% to 0.02%).
“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 [opioid treatment program] take-home policy changes,” the authors wrote.