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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.

Abstract

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.

References
1.
Volkow  ND .  Collision of the COVID-19 and addiction epidemics.   Ann Intern Med. 2020;173(1):61-62. doi:10.7326/M20-1212 PubMedGoogle ScholarCrossref
2.
Czeisler  ME , Lane  RI , Petrosky  E ,  et al.  Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24-30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1 PubMedGoogle ScholarCrossref
3.
National Center for Health Statistics, Centers for Disease Control and Prevention. Provisional drug overdose death surveillance. May 23, 2022. Accessed June 21, 2022. https://www.cdc.gov/nchs/nvss/vsrr/provisional-drug-overdose.htm
4.
Goodnough  A . Overdose deaths have surged during the pandemic, CDC data shows. The New York Times. April 14, 2021. Accessed November 17, 2021. https://www.nytimes.com/2021/04/14/health/overdose-deaths-fentanyl-opiods-coronaviurs-pandemic.html
5.
Ochalek  TA , Cumpston  KL , Wills  BK , Gal  TS , Moeller  FG .  Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic.   JAMA. 2020;324(16):1673-1674. doi:10.1001/jama.2020.17477 PubMedGoogle ScholarCrossref
6.
Mattick  RP , Breen  C , Kimber  J , Davoli  M .  Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.   Cochrane Database Syst Rev. 2009;(3):CD002209. doi:10.1002/14651858.CD002209.pub2PubMedGoogle ScholarCrossref
7.
Mattick  RP , Breen  C , Kimber  J , Davoli  M .  Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.   Cochrane Database Syst Rev. 2014;(2):CD002207. doi:10.1002/14651858.CD002207.pub4 PubMedGoogle ScholarCrossref
8.
Roy  PJ , Choi  S , Bernstein  E , Walley  AY .  Appointment wait-times and arrival for patients at a low-barrier access addiction clinic.   J Subst Abuse Treat. 2020;114:108011. doi:10.1016/j.jsat.2020.108011 PubMedGoogle ScholarCrossref
9.
Schwartz  RP , Highfield  DA , Jaffe  JH ,  et al.  A randomized controlled trial of interim methadone maintenance.   Arch Gen Psychiatry. 2006;63(1):102-109. doi:10.1001/archpsyc.63.1.102 PubMedGoogle ScholarCrossref
10.
Schwartz  RP , Jaffe  JH , Highfield  DA , Callaman  JM , O’Grady  KE .  A randomized controlled trial of interim methadone maintenance: 10-month follow-up.   Drug Alcohol Depend. 2007;86(1):30-36. doi:10.1016/j.drugalcdep.2006.04.017 PubMedGoogle ScholarCrossref
11.
Substance Abuse and Mental Health Service Administration (SAMHSA). Opioid treatment program (OTP) guidance. Updated March 19, 2020. Accessed August 2, 2021. https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf
12.
Andraka-Christou  B , Bouskill  K , Haffajee  RL ,  et al.  Common themes in early state policy responses to substance use disorder treatment during COVID-19.   Am J Drug Alcohol Abuse. 2021;47(4):486-496. doi:10.1080/00952990.2021.1903023 PubMedGoogle ScholarCrossref
13.
The Substance Abuse and Mental Health Service Administration (SAMHSA). FAQs: provision of methadone and buprenorphine for the treatment of opioid use disorder in the COVID-19 emergency. Updated April 1, 2020. Accessed April 8, 2022. https://www.samhsa.gov/sites/default/files/faqs-for-oud-prescribing-and-dispensing.pdf
14.
Drug Enforcement Administration, US Department of Justice. Use of telephone evaluations to initiate buprenorphine prescribing. March 31, 2020. Accessed April 8, 2022. https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf
15.
Piper  BJ , Shah  DT , Simoyan  OM , McCall  KL , Nichols  SD .  Trends in medical use of opioids in the US, 2006-2016.   Am J Prev Med. 2018;54(5):652-660. doi:10.1016/j.amepre.2018.01.034 PubMedGoogle ScholarCrossref
16.
Brothers  S , Viera  A , Heimer  R .  Changes in methadone program practices and fatal methadone overdose rates in Connecticut during COVID-19.   J Subst Abuse Treat. 2021;131:108449. doi:10.1016/j.jsat.2021.108449 PubMedGoogle ScholarCrossref
17.
Alexander  GC , Stoller  KB , Haffajee  RL , Saloner  B .  An epidemic in the midst of a pandemic: opioid use disorder and COVID-19.   Ann Intern Med. 2020;173(1):57-58. doi:10.7326/M20-1141 PubMedGoogle ScholarCrossref
18.
Tracy  K , Wachtel  L , Friedman  T .  The impact of COVID-19 on opioid treatment program (OTP) services: where do we go from here?   J Subst Abuse Treat. 2021;131:108394. doi:10.1016/j.jsat.2021.108394 PubMedGoogle ScholarCrossref
19.
Currie  JM , Schnell  MK , Schwandt  H , Zhang  J .  Prescribing of opioid analgesics and buprenorphine for opioid use disorder during the COVID-19 pandemic.   JAMA Netw Open. 2021;4(4):e216147. doi:10.1001/jamanetworkopen.2021.6147 PubMedGoogle ScholarCrossref
20.
Cantor  J , Dick  AW , Haffajee  R ,  et al.  Use of buprenorphine for those with employer-sponsored insurance during the initial phase of the COVID-19 pandemic.   J Subst Abuse Treat. 2021;129:108384. doi:10.1016/j.jsat.2021.108384 PubMedGoogle ScholarCrossref
21.
Huskamp  HA , Busch  AB , Uscher-Pines  L , Barnett  ML , Riedel  L , Mehrotra  A .  Treatment of opioid use disorder among commercially insured patients in the context of the COVID-19 pandemic.   JAMA. 2020;324(23):2440-2442. doi:10.1001/jama.2020.21512 PubMedGoogle ScholarCrossref
22.
Maxwell  JC , McCance-Katz  EF .  Indicators of buprenorphine and methadone use and abuse: what do we know?   Am J Addict. 2010;19(1):73-88. doi:10.1111/j.1521-0391.2009.00008.x PubMedGoogle ScholarCrossref
23.
Drug Enforcement Administration Diversion Control Division. Automation of Reports and Consolidated Orders System (ARCOS). US Dept of Justice. Updated April 5, 2022. Accessed November 15, 2021. https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/
24.
Federal Reserve Bank of St Louis. Population [B230RC0Q173SBEA]. Updated April 28, 2022. Accessed December 5, 2021. https://fred.stlouisfed.org/series/B230RC0Q173SBEA
25.
Kampman  K , Jarvis  M .  American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use.   J Addict Med. 2015;9(5):358-367. doi:10.1097/ADM.0000000000000166 PubMedGoogle ScholarCrossref
26.
Furst  JA , Mynarski  NJ , McCall  KL , Piper  BJ .  Pronounced regional disparities in United States methadone distribution.   Ann Pharmacother. 2022;56(3):271-279. doi:10.1177/10600280211028262PubMedGoogle ScholarCrossref
27.
US Census Bureau. 2019 National and state population estimates. Revised October 8, 2021. Accessed December 5, 2021. https://www.census.gov/newsroom/press-kits/2019/national-state-estimates.html
28.
Cance  JD , Doyle  E .  Changes in outpatient buprenorphine dispensing during the COVID-19 pandemic.   JAMA. 2020;324(23):2442-2444. doi:10.1001/jama.2020.22154 PubMedGoogle ScholarCrossref
29.
Chalasani  R , Shinabery  JM , Goetz  CT ,  et al.  Buprenorphine dispensing in Pennsylvania during the COVID-19 pandemic, January to October 2020.   J Gen Intern Med. 2021;36(12):3915-3917. doi:10.1007/s11606-021-07083-y PubMedGoogle ScholarCrossref
30.
Joudrey  PJ , Adams  ZM , Bach  P ,  et al.  Methadone access for opioid use disorder during the COVID-19 pandemic within the United States and Canada.   JAMA Netw Open. 2021;4(7):e2118223. doi:10.1001/jamanetworkopen.2021.18223 PubMedGoogle ScholarCrossref
31.
Amram  O , Amiri  S , Thorn  EL , Lutz  R , Joudrey  PJ .  Changes in methadone take-home dosing before and after COVID-19.   J Subst Abuse Treat. 2022;133:108552. doi:10.1016/j.jsat.2021.108552 PubMedGoogle ScholarCrossref
32.
Pashmineh Azar  AR , Cruz-Mullane  A , Podd  JC ,  et al.  Rise and regional disparities in buprenorphine utilization in the United States.   Pharmacoepidemiol Drug Saf. 2020;29(6):708-715. doi:10.1002/pds.4984 PubMedGoogle ScholarCrossref
33.
Tilhou  AS , Dague  L , Saloner  B , Beemon  D , Burns  M .  Trends in engagement with opioid use disorder treatment among Medicaid beneficiaries during the COVID-19 pandemic.   JAMA Health Forum. 2022;3(3):e220093. doi:10.1001/jamahealthforum.2022.0093 Google ScholarCrossref
34.
Harris  MTH , Lambert  AM , Maschke  AD , Bagley  SM , Walley  AY , Gunn  CM .  “No home to take methadone to”: experiences with addiction services during the COVID-19 pandemic among survivors of opioid overdose in Boston.   J Subst Abuse Treat. 2022;135:108655. doi:10.1016/j.jsat.2021.108655 PubMedGoogle ScholarCrossref
35.
Joudrey  PJ , Edelman  EJ , Wang  EA .  Drive times to opioid treatment programs in urban and rural counties in 5 US states.   JAMA. 2019;322(13):1310-1312. doi:10.1001/jama.2019.12562 PubMedGoogle ScholarCrossref
36.
Amiri  S , McDonell  MG , Denney  JT , Buchwald  D , Amram  O .  Disparities in access to opioid treatment programs and office-based buprenorphine treatment across the rural-urban and area deprivation continua: a US nationwide small area analysis.   Value Health. 2021;24(2):188-195. doi:10.1016/j.jval.2020.08.2098 PubMedGoogle ScholarCrossref
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