Victor Roy , Michele J. Buonora , Cristina Murray-Krezan , Anthony Fabio , Paul J. Joudrey
{"title":"美国各州选择退出扩大美沙酮带回家政策和相关死亡率。","authors":"Victor Roy , Michele J. Buonora , Cristina Murray-Krezan , Anthony Fabio , Paul J. Joudrey","doi":"10.1016/j.josat.2025.209800","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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), <em>p</em> = 0.47]. Adjustments for non-methadone-related overdose variables yielded similar results.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"179 ","pages":"Article 209800"},"PeriodicalIF":1.9000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"U.S. states opting out of expanded methadone take-home policies and associated mortality\",\"authors\":\"Victor Roy , Michele J. Buonora , Cristina Murray-Krezan , Anthony Fabio , Paul J. Joudrey\",\"doi\":\"10.1016/j.josat.2025.209800\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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), <em>p</em> = 0.47]. Adjustments for non-methadone-related overdose variables yielded similar results.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":73960,\"journal\":{\"name\":\"Journal of substance use and addiction treatment\",\"volume\":\"179 \",\"pages\":\"Article 209800\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of substance use and addiction treatment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2949875925001791\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"0\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of substance use and addiction treatment","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949875925001791","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"0","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:历史上,联邦法规限制带回家的美沙酮剂量主要是由于担心美沙酮过量。为了应对COVID-19大流行,2020年3月的一项紧急联邦政策允许各州扩大美沙酮的带回家剂量。我们的目标是利用州层面上的变化来比较选择加入和退出扩大的带回家剂量的州与选择加入并继续该政策的州之间美沙酮相关的过量死亡率的变化。方法:采用扩展的双向固定效应差分法(DID)。干预组包括最初选择加入然后退出扩大的带回家剂量的州,而对照组包括选择加入并继续执行该政策的州。我们的主要结局是使用2020年4月至2022年12月每10万人中美沙酮相关过量死亡的季度率对治疗状态(ATET)的平均治疗效果。数据来源包括州政策审查、CDC WONDER和美国人口普查局。结果:干预组包括三个选择退出扩大带回家剂量的州,而对照组包括16个维持政策的州。我们发现选择退出扩大的带回家剂量与美沙酮相关的过量死亡率之间没有显著关联[ATET = 0.02,95 % CI = (-0.03,0.47),p = 0.47]。对与美沙酮无关的用药过量变量进行调整,也得到了类似的结果。结论:与退出政策的州相比,继续扩大美沙酮带回家剂量的州随后并未出现美沙酮相关过量死亡的可检测到的增加。这一证据表明,扩大美沙酮带回家的政策在人口水平上是安全的,这可以为目前保持严格限制的州的审议提供信息。
U.S. states opting out of expanded methadone take-home policies and associated mortality
Background
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.
Methods
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.
Results
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.
Conclusion
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.