Patients were allowed to take home methadone at the start of the pandemic. A new study shows overdoses didn’t go up.

Letting people in addiction take at home a highly regulated medication used in treatment, rather than requiring them to show up at clinics for their daily doses of the drug called methadone, didn’t cause a rise in overdoses, according to a new study released this week.

In the early days of the COVID-19 pandemic, in an effort to prevent the spread of the virus, federal officials relaxed long-standing rules around the dispensing of methadone, a widely used and effective treatment for opioid addiction.

Methadone is one of the country’s most heavily regulated medications, largely because of fears it could cause overdoses or be sold on the street.

Methadone staves off the painful withdrawal symptoms that otherwise might send people who use opioids in search of street drugs. People who take opioid-based addiction treatment medications are more likely to enter lasting recovery than people who quit cold turkey.

Before the pandemic, methadone patients were, for the most part, required to take the medication every day at a clinic under medical supervision. The ability to offer patients take-home doses was limited, often granted only as a privilege to some patients after years at a clinic.

“We don’t have any other treatment for which we demand patients go on a daily basis for an oral dose of medication,” said Nora Volkow, director of the National Institute on Drug Abuse and one of the study’s authors. “That’s part of the way we’ve stigmatized the treatment of addiction, making it harder for people to receive medications which can be really helpful.”

The pandemic made in-person medical appointments risky — and so the regulations were relaxed, allowing far more patients to take home up to a month’s supply of methadone to prevent the spread of the virus. At the time, federal officials also feared that some patients would sell their methadone on the street, potentially causing overdoses.

“I was worried,” Volkow said. “If you get methadone and inject it, [the effect] can be very rewarding. And it can have a value on the black market.”

Volkow and several colleagues at NIDA analyzed data on overdose deaths involving methadone from 2019 and 2020, plus provisional overdose death data from 2021. They found their concerns were unwarranted in an article published in JAMA Psychiatry on Wednesday.

Study authors saw a modest increase in methadone-involved overdose deaths in March 2020 — tracking a rise in all overdose deaths at the outset of the pandemic. But afterward, methadone-related overdose deaths actually decreased slightly, by about 0.05%. That’s consistent with a trend in methadone-related overdose deaths that existed before the pandemic.

“There’s absolutely no evidence that the relaxation of laws for take-home methadone in any way increases the number of methadone overdose deaths,” Volkow said.

Most people who died of methadone-related overdoses in the time period the study looked at also had fentanyl in their systems, suggesting that they had taken both methadone and street drugs, she said.

Advocates for people with addiction have been calling for less stringent regulations around methadone for years.

A qualitative study published in the Journal of Harm Reduction last year — led by a researcher who is himself a long-term methadone patient — interviewed patients who said the requirement to show up daily for a single dose made it difficult to hold a job, travel, rest if they were sick, or generally carry on normal life.

Volkow said she hopes the NIDA study will persuade federal authorities to continue the pandemic-era changes to methadone availability.

“There is this fear that once the declaration of emergency for COVID is terminated, that [clinics] will go back to the way they did things in the past,” she said. “We wanted to provide as much evidence as possible to substantiate the value of making these changes permanent.”