Take-Home Methadone Linked With Reduced Overdose Deaths in Black, Hispanic Men

Monthly methadone-involved overdose deaths decreased among Black and Hispanic men in the US after a federal policy change allowed states to ease restrictions on take-home methadone doses for treatment-adherent patients, according to a study in JAMA Health Forum.

“On March 16, 2020, in response to the first wave of the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients,” explained corresponding author Rebecca Arden Harris, MD, MSc, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and study coauthors.

The population-based cohort study examined 14,529 methadone-involved deaths between January 1, 2018, and June 30, 2022. To investigate how the relaxed restrictions on take-home methadone affected different racial, ethnic, and sex groups, researchers conducted an interrupted time series analysis of monthly fatal overdoses for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.

Among Black and Hispanic men, a slightly increasing number of methadone-involved deaths became a sharply decreasing slope after the take-home methadone policy change, according to the study. However, the policy change was not associated with a change in methadone for Black, Hispanic, or White women, or White men.

“We did not expect to find differential associations based on demographic group and can only conjecture on the reason for these results: that having to daily report to an OTP [opioid treatment program] is a distressing and demeaning experience for Black and Hispanic men who are already marginalized and continually exposed to systems of surveillance, stigma, alienation, and punishment,” researchers wrote. “The additional take-home doses provided a sense of normalcy and dignity that was missing with frequent attendance at the OTP.”

Results from the analysis show a clear association between the take-home policy and race and ethnicity regardless of the reason, the authors pointed out.

“The urgency of the drug overdose crisis requires that our national methadone policy debates and decisions attend to the heterogeneity of people in treatment,” they wrote.

Reference

Harris RA, Long JA, Bao Y, Mandell DS. Racial, ethnic, and sex differences in methadone-involved overdose deaths before and after the US federal policy change expanding take-home methadone doses. JAMA Health Forum. 2023;4(6):e231235. doi: 10.1001/jamahealthforum.2023.1235