Aims: Following the UK lockdown on March 23rd 2020, many patients on daily supervised methadone consumption were switched to ‘take-home’ two-week prescriptions to reduce footfall in pharmacies, support the ‘stay at home’ message, and mitigate potential pharmacy closures. This research aims to evaluate the impact of this change on methadone-related mortality in England.

Methods: Methadone-related deaths reported to the National Programme on Substance Abuse Deaths (NPSAD) that occurred March 23rd-June 22nd in 2016-2020 were extracted for analysis.

Results: Using 2016-2019 reporting statistics, 140 methadone-related deaths for this 3-month period in 2020 could be anticipated. However, by April 22nd 2021 NPSAD had already received 166 reports, with a further 40 reports projected to be received based upon previous reporting trends. Methadone-related deaths in 2020 are therefore estimated to increase by 65% in comparison to 2019 (2019 n=125; 2020 n=206). When delineating by source of obtainment, the proportion of decedents prescribed methadone increased on average by 14% for 2016-2019, and by 10% where methadone was illicitly sourced. In 2020, the increase in prescribed methadone deaths remained stable at 14%, whilst those from illicitly sourced methadone rose by 42%.

Conclusions: The switch to take-home methadone prescriptions has not affected mortality rates in individuals prescribed methadone. However, deaths where methadone was illicitly procured have increased, likely due to the diversion of prescribed methadone. Changes to dispensing should consider harms to those not in treatment in addition to the treatment population. A more nuanced approach to take-home dosing should be further explored.