Treatment initiations and opioid overdoses among recently incarcerated people after adoption of the take-home methadone policy

Abstract

Opioid overdose is the leading cause of death among recently incarcerated people. Take-home methadone flexibilities adopted at the COVID-19 pandemic’s outset may have facilitated opioid use disorder treatment initiations and prevented opioid overdoses for this population. These flexibilities may have particularly enhanced treatment initiations for rural residents, given relaxed in-person methadone treatment requirements. Leveraging the Massachusetts Department of Public Health’s Public Health Data Warehouse, we assessed whether the Massachusetts take-home methadone policy was associated with changes in post-release initiations of medications for opioid use disorder (MOUD) (i.e., methadone, buprenorphine, and extended-release naltrexone) and opioid overdoses among recently released people, including rural residents. Results show that the monthly initiation rate of any MOUD within 7 days of release did not change after the policy. However, when disaggregating by MOUDs, we find a trend divergence, with increases in methadone offsetting decreases in other MOUDs. After the policy, the monthly rate of methadone initiations increased significantly. By contrast, the monthly rate of buprenorphine initiations decreased, and the monthly rate of extended-release naltrexone initiations remained stable. These patterns generally held among rural residents, who experienced significantly higher methadone initiation rates relative to urban residents after the policy. Furthermore, in contrast to increased opioid overdose rates in Massachusetts and the United States during the pandemic, the monthly adjusted rate of fatal and non-fatal opioid overdoses within 90 days of release remained stable. These findings suggest that take-home methadone flexibilities may facilitate methadone initiations for recently incarcerated individuals, particularly rural residents, and potentially prevent opioid overdoses.