Should Relaxed Methadone Rules Continue After the Pandemic Ends?

Dramatic changes to regulations on medications for the treatment of opioid use disorder (OUD) were enacted rapidly in the United States early in 2020 as a reaction to the coronavirus disease 2019 (COVID-19) pandemic. A commentary, published in the Journal of Substance Abuse and Treatment, discussed these changes and recommended which avenues of research are needed to understand the impact of the new regulations.

During the ongoing opioid epidemic in the United States, there were an estimated 2 million individuals living with OUD and deaths due to opioid overdose have increased 4-fold since 2002. Methadone and buprenorphine have been the gold-standard for treating OUD, but until recently, they were only accessible through specially licensed physicians, and weekly in-person monitoring and counseling were required for treatment initiation.

In reaction to social distancing recommendations and stay-at-home orders, in February 2020, patients were allowed to use telemedicine as an alternative to in-person follow-up visits, and in March, patients were permitted to have 14- or 28-day take-home methadone supplies.

Some clinicians have argued for these regulation changes to become permanent; however, few data-driven results are available to assess the safety and long-term consequences of these policy changes.

In order to decide whether these altered policies should remain, the commentary authors recommend that these 4 questions be studied to help formulate best-practice recommendations:

How have these policy exemptions altered care? Has access to mutual help meetings or naloxone been reduced?

How have overdose rates, emergency department visits, and other associated events changed since the new regulations were enacted?

What support is needed for clinicians? Are some clinics unable or unwilling to adopt changes?

What innovative strategies been most successful during this time?

The authors concluded that answering these questions using a data-driven approach may be the most effective strategy for implementing the safest and most effective guidelines for treating individuals with OUD.

Reference

Livingston NA, Ameral V, Banducci AN, Weisberg RB. Unprecedented need and recommendations for harnessing data to guide future policy and practice for opioid use disorder treatment following COVID-19. J Subst Abuse Treat. 2020;108222. doi:10.1016/j.jsat.2020.108222