Did drug use increase following COVID-19 relaxation of methadone take-out regulations? 2020 was a complicated year.

BACKGROUND

Relaxation of federal regulations for methadone take-out dosing during the COVID-19 pandemic is unprecedented. The impact of this change on drug use is unknown. This study explores the impact of the federal take-out variance on drug use in one urban opioid treatment program as measured by drug testing.

METHODS

This study collected drug test results from 613 patients receiving methadone from July 2020, following COVID-19-related take-out dose adjustments, and July 2019 for comparison. Using a generalized linear mixed model, we computed the average estimated probability of a positive drug test for each year for each take-out phase. To isolate the effect of changing take-out, we removed the main effect of year, while retaining the main effect of take-out phase and the interaction between year and phase.

RESULTS

The percent of drug tests positive for opiates, benzodiazepines, and methamphetamine was greater in July 2020 than in July 2019 (p < 0.001 for each), while the percent of tests negative for methadone increased (p < 0.001). Oxycodone, barbiturate, and cocaine positive tests remained stable. In a separate analysis of opioid and non-opioid test results, take-out phase was associated with both opioid and non-opioid positive results (p < 0.001, each outcome). The association of take-out phase with opioid and non-opioid positive results differed in the two years (year-by-phase interaction p < 0.025, each outcome). After removing the year main effect, the rate of positive tests was lower in 2020 for the smallest number of take-out doses, higher for a moderate number of take-out doses, and about the same for the highest number of take-out doses.

CONCLUSIONS

Positive opioid and non-opioid drug tests increased following the federal variance allowing more methadone take-out doses, but these findings cannot fully be attributed to alterations in the take-out schedule.