Changes to methadone maintenance therapy in the United States, Canada, and Australia during the COVID-19 pandemic: A narrative review

https://doi.org/10.1016/j.josat.2023.209086Get rights and content

Highlights

  • •

    Methadone regulations were loosened during the COVID-19 pandemic.

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    Clinics dispensed increased take-home doses and performed less drug testing.

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    These changes to policy did not lead to worse treatment outcomes.

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    Both patients and clinicians reported positive views of these changes.

Abstract

Introduction

In response to the COVID-19 pandemic, countries across the world made adaptations to policies regulating the provision of methadone maintenance therapy (MMT) to facilitate social distancing for health care providers and people in treatment. Many countries issued guidance about increasing take-home methadone doses after the onset of the pandemic.

Methods

In this review, we compare the regulation of MMT prior to the pandemic in the United States, Canada, and Australia, analyze changes to treatment policy in the context of COVID-19, and review emerging data on treatment outcomes.

Results

The United States only permits the prescription and disbursement of methadone for MMT treatment at federally designated opioid treatment programs (OTPs). Conversely, Australia and Canada operate on a community pharmacy-based distribution model, where patients can access methadone doses either in participating pharmacies or in some methadone clinics.

Conclusion

Given reports of similar treatment outcomes and increased patient satisfaction since the pandemic-related policy changes, some changes including increased receipt of take-home doses should be considered for incorporation into post-pandemic treatment policies and regulations.

Section snippets

Introduction/background

Methadone is a long-acting opioid receptor agonist and an evidence-based treatment for opioid use disorder (OUD). Patients with OUD treated with methadone have better clinical outcomes, improved quality of life, and decreased risk of mortality compared to patients not in treatment (National Academies of Sciences, 2019). Despite this, methadone as a treatment for OUD is difficult to access and highly regulated in many countries, resulting in a significant number of those who might benefit from

Methadone treatment prior to COVID-19

In the United States, methadone is considered a schedule II substance, along with drugs such as hydromorphone, oxycodone, and fentanyl (Lists of: Scheduling actions controlled substances regulated chemicals, 2021). The US Drug Enforcement Administration “schedules” drugs based upon their evaluation of the drug's acceptable medical use as well as its potential for unhealthy use or dependence. Both methadone scheduling and the regulations surrounding its delivery were heavily influenced by fears

Methadone treatment prior to COVID-19

In Canada, the regulatory environment for methadone is more flexible than in the United States. Methadone is considered a controlled substance that is regulated under the Controlled Drugs and Substances Act (CDSA) and the Narcotic Control Regulations (NCR), but as of 2018 practitioners are no longer required to obtain an exemption from Health Canada to prescribe (Methadone program, 2017). Practice standards for MOUD prescribing in Canada are established individually by provincial bodies and,

Methadone treatment prior to COVID-19

In Australia, methadone is considered a schedule 8 medicine under the Standard for the Uniform Scheduling of Medicines and Poisons along with morphine, oxycodone, and codeine (The Poisons Standard (the SUSMP), 2022). Schedule 8 medicines, including methadone, are regulated at a state or territory level and are classified as such due to their risk of unhealthy use or dependence. Methadone program service delivery is supported in each jurisdiction by local policies that generally align with

Conclusion

Across all three countries, regulators of methadone treatment programs responded with increasing access to take-home doses, loosening restrictions on MMT via telehealth, and decreasing requirements for urine drug screening. However, they differed in regard to the length of time that these COVID-era exemptions were in effect, as some settings in Canada have already rolled back take-home dosing flexibilities, while the US federal government has sought to extend them.

Issues of access to methadone

Declaration of comepting interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

CRediT authorship contribution statement

The authors have participated sufficiently in the conception and design of this work, as well as the writing of the manuscript, to take public responsibility for it. The authors believe this review manuscript represents valid work.

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