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

Abstract

IMPORTANCEThe 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. RESULTSThe 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 RELEVANCEThis 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.

Reversal of increases in methadone distribution for opioid use disorder in the US during the COVID-19 pandemic

“…The strengths of this report include novel and timely data from ARCOS which is comprehensive for both distribution and number of distributors. This investigation extends upon earlier research both pre [4] and post COVID-19 pandemic [31,32].…”

“…The strengths of this report include novel and timely data from ARCOS which is comprehensive for both distribution and number of distributors. This investigation extends upon earlier research both pre [4] and post COVID-19 pandemic [31, 32]. Potential caveats and limitations stem from the fact that methadone distribution is reported in ARCOS by weight rather than prescriptions per individual at an OTP.…”

“…This study obtained data from the Drug Enforcement Administration's (DEA) Automated Reports and Consolidated Ordering System (ARCOS), a federal program established by the 1970 Controlled Substances Act, to monitor the distribution of DEA controlled substances from various sources including retail pharmacies, hospitals, practitioners, teaching institutions, mid-level practitioners, and OTPs. Previous pharmacoepidemiologic studies have also utilized the ARCOS database [28][29][30][31][32]. It is important to note that ARCOS does not provide information on the number of patients receiving methadone.…”

Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England

“…Differences in drug markets may also have contributed: in the United States fentanyl accounted for a greater proportion of deaths during early 2020 ( Macmadu et al, 2021 ), whereas in our sample fentanyl detections remained very rare. Differences in treatment approaches could also have impacted: in the United States methadone supply was reduced in some states ( Chen and Powell, 2022 ) and a significant minority of services stopped taking new patients ( Joudrey et al, 2021 ) whereas in the UK treatment facilitating access to OAT was emphasised ( Public Health England 2020 ) and there is some evidence that it could be accessed more quickly during the pandemic than prior to COVID-19 ( Schofield et al, 2020 , Kesten et al, 2021 ).…”

Pronounced State Level Disparities in Medicaid Prescribing of Buprenorphine for Opioid Use Disorder (2019-2020)

“…3 While buprenorphine and methadone are core MOUDs, use of buprenorphine in particular has been increasing over the past 2 decades. 4,5 Buprenorphine is a partial mu agonist with a high affinity for the mu receptor and a slow dissociation from the receptor, making it more difficult to displace. However, at typical OUD doses (e.g.…”