Harris Rebecca Arden, Long Judith A, Bao Yuhua, Kranzler Henry R, Perrone Jeanmarie, Mandell David S
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Drug Alcohol Depend Rep. 2025 Apr 24;15:100339. doi: 10.1016/j.dadr.2025.100339. eCollection 2025 Jun.
To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit extended take-home methadone doses: up to 28 days of take-home methadone for stable patients and 14 days for those less stable. This study examined the association between the policy change and fatal methadone overdoses across the urban-rural continuum.
This interrupted time series analysis used the U.S. National Vital Statistics System (NVSS) 2018-2022 mortality data to examine monthly trends in methadone-involved overdose deaths before and after the policy change allowing more take-home methadone doses. Deaths were stratified into six urban-rural categories and by co-involvement of fentanyl.
Prior to the policy change, trends in methadone-involved overdose deaths were either flat or declining across all urbanization categories. Following the policy change, deaths decreased significantly in Large Central Metro areas but increased in rural Micropolitan counties. No trend changes occurred in the other urban or rural categories. When stratified by fentanyl co-involvement, Large Central Metro areas experienced a decrease in methadone deaths with fentanyl, though not statistically significant, and a significant decrease without fentanyl. In rural Micropolitan counties, methadone deaths saw an increase with fentanyl co-involvement that did not reach significance, and a significant increase without fentanyl. Noncore counties saw a significant increase in deaths involving both methadone and fentanyl, with no notable change observed without fentanyl.
Results suggest the need to expand methadone access and treatment supports in underserved rural communities, recognizing that factors beyond the policy change may have contributed to the reported associations.
为降低美沙酮诊所中新冠病毒暴露风险，物质滥用和精神健康服务管理局（SAMHSA）于2020年3月发布了一项法规临时修订案，允许增加美沙酮带回家的剂量：病情稳定的患者可携带长达28天的美沙酮剂量，病情不太稳定的患者可携带14天的剂量。本研究调查了这一政策变化与城乡连续体中美沙酮过量致死之间的关联。
本中断时间序列分析使用了美国国家生命统计系统（NVSS）2018 - 2022年的死亡率数据，以研究在允许增加美沙酮带回家剂量的政策变化前后，涉及美沙酮的过量死亡的月度趋势。死亡病例被分为六个城乡类别，并按是否同时涉及芬太尼进行分层。
在政策变化之前，所有城市化类别中涉及美沙酮的过量死亡趋势要么持平要么下降。政策变化后，大型中心都会区的死亡人数显著下降，但农村微型都市县的死亡人数增加。其他城市或农村类别未出现趋势变化。按是否同时涉及芬太尼分层后，大型中心都会区中，同时涉及芬太尼的美沙酮死亡人数有所下降，虽无统计学意义，但不涉及芬太尼的美沙酮死亡人数显著下降。在农村微型都市县，同时涉及芬太尼的美沙酮死亡人数增加但未达显著水平，不涉及芬太尼的美沙酮死亡人数则显著增加。非核心县中，同时涉及美沙酮和芬太尼的死亡人数显著增加，不涉及芬太尼的则无明显变化。
结果表明，需要在服务不足的农村社区扩大美沙酮获取途径和治疗支持，同时认识到政策变化之外的因素可能导致了所报告的关联。
