U.S. states opting out of expanded methadone take-home policies and associated mortality

Historically, federal regulations limited take-home methadone doses largely due to concerns about methadone-related overdose. In response to the COVID-19 pandemic, an emergency federal policy in March 2020 permitted states to expand take-home methadone doses. Our objective was to utilize state-level variation in take-home expansion to compare changes in methadone related overdose death rates among states that opted into and then out of expanded take-home dosing with states that opted into and continued the policy.

We used an extended two-way fixed effects difference-in-differences (DID) approach. The intervention group included states that initially opted into and then out of expanded take-home dosing, while the comparison group included states that opted into and continued the policy. Our primary outcome was the average treatment effect on the treated states (ATET) using quarterly rate of methadone-related overdose deaths per 100,000 persons from April 2020 to December 2022. Data sources included a state policy review, CDC WONDER, and U.S. Census Bureau.

The intervention group included three states that opted out of expanded take-home dosing, while the comparison group comprised 16 states maintaining the policy. We found no significant association between opting out of expanded take-home dosing and methadone-related overdose death rates [ATET = 0.02, 95 % CI = (-0.03, 0.47), p = 0.47]. Adjustments for non-methadone-related overdose variables yielded similar results.

States who continued expanded take-home methadone dosing did not subsequently experience a detectable increase in methadone-related overdose deaths relative to states that opted out of the policy. This evidence suggests that policies expanding methadone take-homes are safe at a population level, which can inform deliberations within states that currently maintain strict restrictions.