During the COVID-19 pandemic, the opioid epidemic in the United States surged to an all-time high. To combat this, the US government loosened restrictions on obtaining methadone for the treatment of opioid use disorder. However, are these changes enough to combat opioid-related overdoses?
Methadone use for opioid use disorders requires patients to attend outpatient treatment programs to obtain their daily doses.
The COVID-19 pandemic forced the federal government to ease regulations on methadone, allowing "stable" patients to take 14 or 28 day supplies home.
These measures still fall short of effectively fighting the opioid epidemic and require a greater overhaul of the system.
Despite the overall increase in methadone usage over the past decade, it has plateaued while opioid overdoses have continued to increase at a staggering rate which illustrates the inadequacies of the current treatment strategies.
The federal government eased regulations on methadone
In the US, methadone for the use of an opioid use disorder must be obtained from an opioid treatment program daily. This requires patients to drive to the nearest program fot their daily dose. One way the US government attempted to improve access to methadone during the COVID-19 pandemic was to ease this regulation on its distribution.
The Substance Abuse and Mental Health Services Administration (SAMHSA) began allowing "stable" patients to be allowed to take home doses of methadone. This allowed certain patients to take home 14 or 28 days of medication to reduce face-to-face contact and improve access. However, this measure still required newly diagnosed and those not meeting the criteria as "stable" patients to attend daily dispensing.
Although, many critics suggested that methadone diversion and overdoses would increase with take-home doses. These trends were not seen but still, this measure fell short of making methadone treatment more accessible to the public.
Overall, the trend of methadone usage for opioid use disorders has increased by 61% in the US from 2010 to 2020. But, despite a gradual upward trend from 2010 to 2019, it plateaued in 2020 and decreased by 5% in 2021. This in conjunction with the rising rate of opioid overdoses highlights the ineffective measures taken to increase methadone availability during the pandemic.
In addition, approximately 10% of outpatient treatment programs were not accepting new patients during the COVID-19 pandemic. Thus further restricting access during an already challenging time for the country.
The stigma of methadone
In the United States, methadone for use in opioid use disorders has been stigmatized for decades. The creation of outpatient treatment programs worked as planned for regulating the use and preventing methadone diversion. However, they created significant challenges for patients to access this life-saving medication while creating a stigma towards people requiring treatment.
The hypocrisy of this method of treatment is highlighted when discussing buprenorphine prescribing for opioid use disorders. Buprenorphine is another medication used to help patients with their heroin and opioid addictions. However, unlike methadone, buprenorphine can be obtained by prescription at any local pharmacy for a monthly supply.
The level of access to buprenorphine is significantly better than that of methadone, despite a recent review showing methadone to be more effective in retaining people in drug treatment programs. Additionally, patients prescribed methadone for chronic pain can obtain their monthly supply at pharmacies via prescription. The restriction on methadone prescribing in opioid use disorders has significantly impacted the United States' battle against opioid overdoses.
The restrictions on the use of methadone for opioid use disorders are crippling the United States' fight in reducing opioid-related overdoses. Although methadone use has increased over the last decade, there is still a long way to go. Altering the US's prescribing patterns to mimic other countries, like the U.K., Canada, and Australia which have successfully implemented doctor office-based programs with prescribing freedom, is the only way to combat the overwhelming opioid epidemic.