What Happened When COVID Eased Methadone Restrictions?

By Leslie Suen, MD, MAS
March 1, 2022

Leslie Suen is an internal medicine physician and health services researcher at the University of California San Francisco. Her research focuses on improving health systems and policies for people with substance use disorders.

More than 100,000 Americans overdosed in the past year, putting our overdose crisis back in the spotlight. The isolation and despair of COVID-19 has contributed to this tragic spike, but it’s also opened the door to new approaches to treating addiction. A recent study in The American Journal of Drug and Alcohol Abuse looks at one of those approaches: take-home methadone.

Methadone is a highly effective treatment for opioid use disorder. But since the 1970s, state and federal laws have required people to get their methadone in-person nearly every day for months or even years before earning take-home doses. Policymakers feared patients would sell their methadone or overdose, but little evidence supports these restrictions, and many experts say they may pose unnecessary barriers to treatment. In March 2020, the federal government eased restrictions in response to COVID-19, allowing methadone clinicians to decide whether patients could receive up to 28 days of take-home doses.

Ofer Amram, Solmaz Amiri, Victoria Panwala, Robert Lutz, Paul Joudrey and Eugenia Socias studied the impact of this change on 183 patients at a methadone clinic in Spokane, Washington. They compared total emergency department (ED) visits, overdose-related ED visits and negative urine tests for methadone 9 months before and after take-home methadone was expanded in March 2020. On average, take-home doses nearly doubled after the change, but there was no significant change in ED visits or negative urine tests.

Some caveats: This study only followed a small number of people at one methadone clinic for a short period of time, so we can’t say if the results would hold for a larger population in more places. But it mirrors other early findings suggesting that loosening requirements may not lead to the harms or illegal drug sales policymakers originally feared. In fact, some research shows it has actually improved patients’ quality of life and enabled treatment stabilization.

Policymakers are taking notice. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) cited this study when it announced in November it would keep the take-home flexibility in place for at least one year after the federal public health emergency expires. It’s also been cited by members of Congress proposing legislation to expand take-home methadone and allow it to be dispensed in community pharmacies, which could decrease barriers, especially for rural populations. Other experts say it’s time to go further by expanding methadone to primary care settings, similar to other countries. 

Methadone policy is at a turning point, and we need more research like this to point the way toward creating more fair, evidence-based policies governing this life saving treatment.

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