Examination of methadone involved overdoses during the COVID-19 pandemic. (March 2023)

• Record Type: Journal Article
• Authors: Kaufman, Daniel E.; Kennalley, Amy L.; McCall, Kenneth L.; Piper, Brian J.
• Is Part Of: Forensic science international. Volume 344(2023)
• Publication Date: 2023-03
• Subjects: Opioid -- Opiate -- Addiction -- Pain -- Overdose -- Coronavirus-19; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2023.111579
• Languages: English
• ISSNs: 0379-0738

Abstract

Abstract: Background: The US opioid overdose epidemic continues to escalate. The restrictions on methadone availability including take-home dosing were loosened during the COVID-19 pandemic although there have been concerns about the high street value of diverted methadone. This report examined how fatal overdoses involving methadone have changed over the past two-decades including during the pandemic. Methods: The CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER) was used to find the unintentional methadone related overdose death rate from 1999 to 2020. Unintentional methadone deaths were defined using the ICD X40–44 codes with only data for methadone (T40.3). Data from the DEA's Automation of Reports and Consolidated Orders System (ARCOS) on methadone overall use, opioid treatment programs use, and pain management use was gathered for all states for 2020 and corrected for population. Results: There have been dynamic changes over the past two-decades in methadone overdoses. Overdoses increased from 1999 (0.9/million) to 2007 (15.9) and declined until 2019 (6.5). Overdoses in 2020 (9.6) were 48.1% higher than in 2019 (t(50) = 3.05, p < .005). The state level correlations between overall methadone use (r(49) = +0.75, p < .001), and opioid treatment program use (r(49) = +0.77, p < .001) with overdoses were positive, strong, and statistically significant. However, methadone use for pain treatment was not associated with methadone overdoses (r(49) = −0.08). Conclusions: Overdoses involving methadone significantly increased by 48.1% in 2020 relative to 2019. Policy changes that were implemented following the COVID-19 pandemic involving methadone take-homes may warrant further study before they are made permanent. Graphical Abstract: ga1 Highlights: Methadone is used to treat opioid use disorder and pain. Methadone take-home policies in the US changed in 2020 to accommodate COVID-19. Overdoses in the US involving methadone were 48% higher in 2020 than 2019. There was a strong correlation between methadone distribution for OUD and overdoses. Methadone distribution for pain was not associated with methadone overdoses.