COVID-19 Linked with Disruptions to Medication for Opioid Use Disorder

There was a significant decline in the supply of methadone but no disruption to the buprenorphine supply in the United States during the COVID-19 pandemic, according to a study published in JAMA Network Open.

Pronounced disparities in the methadone supply were observed across states, with some states experiencing supply reductions as great as 50%.

“The opioid crisis has been exacerbated by the COVID-19 pandemic in the US, with concerns over major disruptions to medication treatment of opioid use disorder,” the authors wrote.

Methadone and buprenorphine are among the most effective medications to treat opioid use disorder (OUD). During the pandemic, restrictions on medications for OUD were relaxed, given the potential adverse effects of supply disruption. Although these changes facilitated greater use of telehealth and greater flexibility in the provision of take-home methadone doses, methadone continued to be more difficult to access than buprenorphine.

Buprenorphine can be distributed through retail pharmacies and may be prescribed without an in-person evaluation by clinicians with waivers. In contrast, methadone can only be dispensed by opioid treatment programs and in-person evaluations or multiple telehealth visits are required to prescribe methadone.

Therefore, researchers sought to understand how the pandemic would affect the supply of these medications, given the different barriers to access. Researchers conducted a cross-sectional study to investigate whether the COVID-19 pandemic was associated with disruption of buprenorphine and methadone supplies in the United States.

They used data from the Automated Reports and Consolidated Ordering System (ARCOS), which monitor the flow of controlled substances in the United States. Data were collected from January 1, 2012, through June 30, 2021.

Researchers included manufacturers and point of sale or distribution at the dispensing or retail level, including hospitals, retail pharmacies, clinicians, midlevel clinicians, and teaching institutions in the analysis. The findings indicated that the per capita supply of methadone dropped 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 3.6 mg to 3.7 mg.

The per capita supply of methadone had declined 20% (-2.7 mg) in the second quarter of 2020 compared with the first quarter of 2020. This reduction was the largest observed in recent years. The authors note that the large decline may be partly explained by an increase in methadone supply in quarter 1 of 2020; however, that increase did not appear to explain the full decline that persisted for a year.

The 8% decline in quarter 2 of 2020 was still substantial compared to the mean methadone supply per capita in 2019. The supply had not returned to 2019 levels as of June 2021.

Conversely, the supply of buprenorphine per person increased consistently during the same period. By June 2021, the mean per capita supply had grown 7% compared with quarter 1 of 2020.

The buprenorphine supply in the United States had been increasing since the early 2000s, and the increase continued through the COVID-19 pandemic. The authors suggest that this increase is possibly due to legal changes designed to reduce barriers to medication access.

Researchers observed considerable state disparities in the reduction of the methadone supply during the pandemic. Per capita supply decreases were experienced in 35 states and Washington, DC, including 50% reductions in New Hampshire and Florida.

A total of 16 states experienced more than a 10% decrease in methadone supply, many being southern states; however, 15 states experienced an increase in the methadone supply.

Notably, the decreases in per capita methadone supply were not compensated by proportional increased in the per capita buprenorphine supply (linear fit, 0.17 [95% CI, −0.43 to 0.76]; P = .47), suggesting that increases in buprenorphine supply per capita were not associated with reductions in methadone supply.

For buprenorphine, there was notable growth or, in rare cases, no change in the supply across states. Overall, researchers found a significant decline in the methadone supply and no disruption to the buprenorphine supply, which exhibited stable growth during the pandemic.

Though the authors encourage further research to explain the state disparities in the methadone supply, they recommend urgent action to help state and local capabilities treat patients with opioid use disorder.

Reference

Chen A Y, Powell D, Stein B D. Changes in buprenorphine and methadone supplies in the US 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.