The change in methadone dispensing requirements in England during the first wave of the COVID-19 pandemic was associated with an increase in deaths from non-prescribed methadone

In March 2020, during the first wave of the coronavirus pandemic and following Public Health England guidance, many patients receiving directly supervised consumption of opioid substitution therapies (namely methadone and buprenorphine) were moved to take-home dispensing to reduce footfall in pharmacies, mitigate potential pharmacy closures, and to support the ‘stay at home’ message in a population particularly vulnerable if they were to contract COVID-19. We aimed to assess whether this change in policy impacted upon methadone- and buprenorphine-related mortality for people both in and out of treatment using toxicology and coroner’s information from the National Programme on Substance Abuse Deaths (NPSAD).

This was a retrospective post-mortem toxicology study. We compared the number of methadone- and buprenorphine-related deaths from prescribed and non-prescribed methadone and buprenorphine which occurred in the 3-month period March 23rd to 22nd June in the years 2016 – 2020 and were reported to NPSAD.

We found an increase of 60% in methadone-related deaths in 2020 compared to 2019 (2019 n=126; 2020 projected n=201). There was no change in the mortality rate of in-treatment decedents. However, a 61% increase in deaths due to non-prescribed methadone in 2020 was observed (2019 n=64; 2020 n=103). There was no change in the number of buprenorphine-related deaths.

Policy makers should consider the risk of diversion and associated harms to those not in treatment in addition to the treatment population when deciding on future requirements for supervised consumption. Such harms should also be weighed against the burden that restrictions place on those in treatment and policy discussions should involve them.