COVID-19 linked to medication disruptions for opioid use disorder
The pandemic has resulted in reductions in methadone supply, but no disruption in the supply of more readily available buprenorphine, although supply disparities have been observed between states.
According to a study published in JAMA network open.
Pronounced disparities in methadone supply have been observed between states, with some states experiencing supply reductions of up to 50%.
“The opioid crisis has been exacerbated by the COVID-19 pandemic in the United States, with concerns about major disruptions in drug treatment for opioid use disorders,” the authors wrote.
Methadone and buprenorphine are among the most effective drugs for treating opioid use disorder (OUD). During the pandemic, restrictions on drugs for OUD were relaxed, given the potential adverse effects of a supply disruption. Although these changes facilitated greater use of telehealth and greater flexibility in providing take-home doses of methadone, methadone continued to be more difficult to access than buprenorphine.
Buprenorphine can be dispensed in retail pharmacies and can be prescribed without in-person assessment by clinicians with waivers. In contrast, methadone can only be dispensed through opioid treatment programs and in-person assessments or multiple telehealth visits are required to prescribe methadone.
Therefore, researchers sought to understand how the pandemic would affect the supply of these drugs, given the different barriers to access. Researchers conducted a cross-sectional study to determine whether the COVID-19 pandemic was associated with a disruption in the supply of buprenorphine and methadone in the United States.
They used data from the Automated Reports and Consolidated Ordering System (ARCOS), which monitors the flow of controlled substances in the United States. Data was collected from January 1, 2012 to June 30, 2021.
The researchers included in the analysis manufacturers and points of sale or distribution at the dispensing or retail level, including hospitals, retail pharmacies, clinicians, mid-level clinicians and educational institutions. The results indicated that the per capita supply of methadone increased from 13.2 mg in the first quarter of 2020 to 10.5 mg in the second quarter of 2020. During the same period, the per capita supply of buprenorphine increased from 3.6mg to 3.7mg.
The supply of methadone per capita had decreased by 20% (-2.7 mg) in the second quarter of 2020 compared to the first quarter of 2020. This reduction was the largest observed in recent years. The authors note that the steep decline may be partly explained by an increase in methadone supply in the first quarter of 2020; however, this increase does not appear to explain the complete decline that has persisted for a year.
The 8% drop in the second quarter of 2020 was still significant compared to the average supply of methadone per capita in 2019. Supply had not returned to 2019 levels by June 2021.
Conversely, the supply of buprenorphine per person has increased steadily over the same period. In June 2021, the average supply per capita had increased by 7% compared to the first quarter of 2020.
The supply of buprenorphine in the United States had increased since the early 2000s, and the increase continued during the COVID-19 pandemic. The authors suggest that this increase may be due to legal changes aimed at reducing barriers to accessing medicines.
Researchers have observed considerable disparities between states in the reduction in methadone supply during the pandemic. Per capita supply declines were recorded in 35 states and Washington, DC, including 50% reductions in New Hampshire and Florida.
A total of 16 states experienced a greater than 10% decline in methadone supply, many of which are southern states; however, 15 states saw an increase in methadone supply.
Notably, decreases in methadone supply per capita were not matched by a proportional increase in buprenorphine supply per capita (linear fit, 0.17 [95% CI, −0.43 to 0.76]; P = 0.47), suggesting that increases in per capita supply of buprenorphine were not associated with reductions in methadone supply.
For buprenorphine, there has been notable growth or, in rare cases, no change in supply between states. Overall, researchers found a significant drop in methadone supply and no disruption in buprenorphine supply, which has shown steady growth during the pandemic.
While the authors encourage further research to explain state disparities in methadone supply, they recommend urgent action to support state and local capacity to treat patients with opioid use disorders. .
Chen AY, Powell D, Stein B D. Changes in the supply of buprenorphine and methadone in the United States during the COVID-19 pandemic. JAMA Netw Open. 2022;5(7):e2223708. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794637. Published July 26, 2022. Accessed July 27, 2022.