Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Health Forum. 2023 Jun 2;4(6):e231235. doi: 10.1001/jamahealthforum.2023.1235.
In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures.
To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups.
DESIGN, SETTING, AND PARTICIPANTS: Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.
On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients.
Monthly methadone-involved overdose deaths.
From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]).
In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.
2020 年 3 月，物质滥用和心理健康服务管理局（SAMHSA）允许各州放宽对治疗依从性患者的美沙酮居家剂量限制，以尽量减少 COVID-19 的暴露。
评估美沙酮居家政策变化是否与不同种族、族裔和性别群体的药物过量死亡有关。
设计、设置和参与者：2018 年 1 月 1 日至 2022 年 6 月 30 日的中断时间序列分析。数据分析于 2023 年 2 月 18 日至 2 月 28 日进行。在这项包括 14529 例美沙酮相关死亡的药物过量死亡率的基于人群的队列研究中，每月记录了 6 个群体的美沙酮相关药物过量死亡人数：西班牙裔男性和女性、非西班牙裔黑人男性和女性以及非西班牙裔白人男性和女性。
2020 年 3 月 16 日，为应对 COVID-19 大流行的第一波，SAMHSA 向各州发布了一项豁免，允许稳定患者最多携带 28 天的美沙酮回家，不稳定患者最多携带 14 天。
每月美沙酮相关过量死亡人数。
从 2018 年 1 月 1 日至 2022 年 6 月 30 日（54 个月），美国共有 14529 例美沙酮相关死亡；在研究的 6 个群体中，有 14112 例（97.1%）发生（黑人男性，1234 例；黑人女性，754 例；西班牙裔男性，1061 例；西班牙裔女性，520 例；白人男性，5991 例；以及白人女性，4552 例）。在黑人男性中，与 2020 年 3 月的政策变化相关的每月美沙酮死亡人数减少（从干预前时期的斜率变化，-0.55 [95%CI，-0.95 至 -0.15]）。西班牙裔男性也经历了与政策变化相关的每月美沙酮死亡人数减少（-0.42 [95%CI，-0.68 至 -0.17]）。在黑人女性、西班牙裔女性、白人男性和白人女性中，政策变化与每月美沙酮死亡人数没有变化（黑人女性，-0.27 [95%CI，-1.13 至 0.59]；西班牙裔女性，0.29 [95%CI，-0.46 至 1.04]；白人男性，-0.08 [95%CI，-1.05 至 0.88]；以及白人女性，-0.43 [95%CI，-1.26 至 0.40]）。
在这项关于每月美沙酮相关过量死亡人数的中断时间序列研究中，居家政策可能有助于减少黑人和西班牙裔男性的死亡，但与黑人和西班牙裔女性或白种男性或女性的死亡无关。
