Background: Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas. Objective: The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States. Methods: The US Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally. Results: The national distribution of methadone increased +12.3% for OTPs but decreased −34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming. Conclusion and Relevance: Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.

Objectives: To identify US prescription trends in methadone distribution for OUD from 2010 to 2020. Methods: The weight of methadone in grams distributed to OTPs per state was derived from the US Drug Enforcement Administration's Automated Reports and Consolidated Ordering System. Methadone was adjusted for state population and compared across all fifty states and Washington DC from 2010 to 2020. Results: The overall distribution of methadone to OTPs significantly (P < 0.0001) increased from 2010 to 2019 (+61.0%) and from 2015 to 2020 (+26.22%). The states with the highest percent change from 2010 to 2020 were Montana (+897.02%), Alaska (+421.11%), and Vermont (+353.67%). In contrast with prior increase of distribution, from 2019 (pre-COVID-19 pandemic) to 2020 (during pandemic), there was no significant change in the distribution of methadone to OTPs (-0.09%). Ohio (+26.02%) significantly increased while Alabama (-21.96%), New Hampshire (-24.13%) and Florida (-28.97%) significantly decreased methadone relative to the national mean. Conclusions: This investigation revealed two trends related to methadone distribution in the US: increased utilization over the past decade and a plateau in utilization from 2019 to 2020. Policies are needed to remove access barriers to methadone treatment during the COVID-19 pandemic in order to reduce the worsening crisis of opioid overdoses in the US.

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ObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

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