Changes in methadone program practices and fatal methadone overdose rates in Connecticut during COVID-19

BACKGROUND: Due to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) has relaxed restrictions on methadone treatment in the United States. There is concern that the relaxation may increase fatal overdose rates. This study examines opioid treatment program (OTP) changes to methadone treatment during COVID-19 and changes in fatal methadone-involved overdose rates in Connecticut. METHODS: From July 8th to August 18th, 2020, we conducted a comprehensive state-wide survey of all eight OTPs that dispense methadone in Connecticut to examine programmatic changes during COVID-19. We also analyzed state-level data on confirmed accidental opioid-involved deaths to assess if relaxation of take-home dosing restrictions and in-person attendance requirements correlated with increased methadone-involved fatal overdose rates. RESULTS: OTPs reported implementing multiple changes to methadone treatment in response to the COVID-19 pandemic. The percent of patients receiving 28-day take-home doses increased from 0.1% to 16.8%, 14-day take-home doses increased from 14.2% to 26.8%, and the percent receiving one or no take-home doses decreased from 37.5% to 9.6%. Monthly or more frequent drug testing decreased from 15% to 4.6% and 75.2% of individual counseling for methadone patients transitioned to telehealth. However, changes to methadone treatment varied considerably by program. OTP providers said restrictions on methadone should be relaxed and increases in take-home dosing as well as telehealth should be continued in non-pandemic situations. Methadone-involved fatalities relative to other opioid-involved fatalities did not increase in Connecticut following changes in OTP practices. CONCLUSIONS: Connecticut OTPs relaxed methadone treatment requirements during COVID-19. Since relaxing restrictions on methadone treatment has not increased fatal overdoses, we recommend that the reductions in-person dosing and attendance requirements implemented during the COVID-19 pandemic should be continued and made permanent.