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Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is the COVID-19 pandemic associated with changes in the US supplies of buprenorphine and methadone?

Findings  This cross-sectional study used quarterly state data on methadone and buprenorphine supplies and found that the per capita supply of methadone declined significantly in the second quarter of 2020 and had not returned to 2019 levels as of June 2021. The per capita supply of buprenorphine increased during the same period.

Meaning  These findings suggest that during the COVID-19 pandemic, the supply of methadone was disrupted, while the supply of buprenorphine was not.


Importance  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.

Objective  To investigate whether the COVID-19 pandemic was associated with disruption of buprenorphine and methadone supplies in the US.

Design, Setting, and Participants  This repeated cross-sectional study used ARCOS (Automated Reports and Consolidated Ordering System) data, which monitor the flow of controlled substances in the US, from January 1, 2012, through June 30, 2021. Manufacturers and point of sale or distribution at the dispensing or retail level, including hospitals, retail pharmacies, clinicians, midlevel clinicians, and teaching institutions, were included in the analysis.

Exposures  COVID-19 pandemic.

Main Outcomes and Measures  Quarterly supplies of buprenorphine and methadone per capita in milligrams.

Results  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, whereas the per capita supply of buprenorphine increased from 3.6 mg to 3.7 mg in the same period. The per capita supply of methadone declined 20% (−2.7 mg) in the second quarter of 2020 compared with the first quarter of 2020, and the supply had not returned to 2019 levels as of June 2021, whereas the supply of buprenorphine per person increased consistently during the same period. There were considerable state disparities in the reduction of the methadone supply during the pandemic, with many states experiencing pronounced per capita supply decreases, including reductions as great as 50% in New Hampshire and Florida. These decreases in per capita methadone supply were not compensated by proportional increases in the per capita buprenorphine supply (linear fit, 0.17 [95% CI, −0.43 to 0.76]; P = .47).

Conclusions and Relevance  This cross-sectional study of buprenorphine and methadone supplies during the COVID-19 pandemic found a pronounced decline in the methadone supply but no disruption to the buprenorphine supply. Future research is needed to explain the pronounced state disparities in the methadone supply.

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Article Information

Accepted for Publication: June 4, 2022.

Published: July 26, 2022. doi:10.1001/jamanetworkopen.2022.23708

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Chen AY et al. JAMA Network Open.

Corresponding Author: Bradley D. Stein, MD, PhD, RAND Corporation, 4570 Fifth Ave, Ste 600, Pittsburgh, PA 15213 (stein@rand.org).

Author Contributions: Dr Chen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Powell.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chen, Powell.

Critical revision of the manuscript for important intellectual content: Powell, Stein.

Statistical analysis: Chen, Powell.

Obtained funding: Stein.

Administrative, technical, or material support: Stein.

Supervision: Powell.

Conflict of Interest Disclosures: Dr Chen reported receiving grants from the National Institute on Drug Abuse (NIDA) during the conduct of the study. Dr Powell reported receiving grants from the NIDA and the Centers for Disease Control and Prevention (CD) during the conduct of the study and grants from the NIDA outside the submitted work. Dr Stein reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and grants from the FORE Foundation outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grants P50DA046351 (Dr Stein), R01DA045800-01 (principal investigator [PI], Dr Stein), and R01CE02999 (PI, Dr Powell) from the CDC.

Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or NIDA.

Additional Contributions: Russell Hanson, BA, BS (RAND Corporation), assisted with the preparation of the data set used in this study. He received no financial compensation beyond his RAND salary.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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