Dr Caroline Copeland is a Senior Lecturer in Pharmacology at King’s College London and Director of the National Programme on Substance Use Mortality (NPSUM), which collects detailed information on drug-related deaths across the UK. Her research focuses on understanding the factors that contribute to drug-related mortality, spanning prescribed and illicit drug use, opioid substitution treatment, novel psychoactive substances and emerging patterns of harm. She uses NPSUM as a real-world research and surveillance resource to identify changes in drug-related deaths, investigate potential risk factors and evaluate the impact of changes in clinical practice and drug policy. She also works with national and international organisations to translate evidence on drug-related mortality into policy and practice.

Abstract

Analysis of methadone-related mortality after COVID-19 service changes in England: Lessons for future opioid substitution treatment delivery

Aims: During the first COVID-19 lockdown in England, many treatment providers reduced or closed supervised opioid substitution treatment services. Almost overnight, take-home methadone dispensing expanded to maintain treatment continuity. Early analyses identified increased methadone-related mortality during this period, but the relative contribution of dispensing changes versus wider pandemic-related disruptions remained unclear, as did whether elevated mortality persisted.

Methods: Methadone-related deaths which occurred in England between January 2016 and March 2024 were identified from the National Programme on Substance Use Mortality. Aggregated dispensing data from four major drug treatment providers in England were used to estimate the proportion of methadone patients receiving take-home prescriptions. Interrupted time-series models examined associations between methadone-related deaths, COVID-19 lockdown periods, and take-home dispensing.

Results: Methadone-related deaths increased sharply during the first COVID-19 lockdown and remained persistently elevated thereafter. Although take-home dispensing and deaths increased concurrently during the lockdown period, interrupted time-series analyses did not demonstrate a robust independent association between dispensing and mortality. In contrast, during the post-lockdown period, take-home dispensing showed a strong association with methadone-related mortality in both contemporaneous (B=0.417, p<0.001) and one-month lagged models (B=0.283, p=0.003).

Conclusions: Increased methadone-related mortality during the first COVID-19 lockdown likely reflected multiple concurrent societal and service disruptions. However, the persistent association between take-home dispensing and deaths observed during the post-lockdown period suggests that sustained changes to dispensing practices may have contributed to ongoing mortality risk. Future opioid substitution treatment policy should focus on how flexible prescribing can be safely implemented within adequately resourced and integrated treatment systems.