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Ivasiy R, Madden LM, Meteliuk A, Machavariani E, Ahmad B, Zelenev A, Desai MM, Bromberg DJ, Polonsky M, Galvez de Leon SJ, Farnum SO, Islam Z, Altice FL. The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine. Addiction 2024; 119:1585-1596. [PMID: 38807448 DOI: 10.1111/add.16565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/24/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND AIMS Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality. DESIGN AND SETTING Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID. PARTICIPANTS In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3 years. MEASUREMENTS Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing. RESULTS Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts. CONCLUSION Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.
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Affiliation(s)
- Roman Ivasiy
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
| | | | - Eteri Machavariani
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Alexei Zelenev
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Maxim Polonsky
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Hodgson K, Bowles JM, Mansoor M, Rooke E, Bardwell G. 'I'm on the coast and I'm on methadone': A qualitative study examining access to opioid agonist treatment in rural and coastal British Columbia. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:117-124. [PMID: 39155634 DOI: 10.4103/cjrm.cjrm_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/12/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Despite rural regions being disproportionately impacted by the toxic drug supply, little is known about the contextual factors influencing access to opioid agonist treatment (OAT) specific to rural residents. The present study examines these factors in a rural and coastal setting in British Columbia, Canada. METHODS The qualitative methods were used to examine the barriers and facilitators to OAT access. Between July and October 2021, semi-structured interviews were conducted with people who use drugs who reside in a rural and coastal community. Thematic analysis was used to identify emergent themes and subthemes. Results were corroborated by the research team and a local community advisory board. RESULTS Twenty-seven (n = 27) participants described both limiting and facilitating factors that influenced OAT accessibility. Access was less challenging when participants' OAT dispensing pharmacy was in close proximity, had extended hours of operation, or when pharmacies provided delivery services. Barriers to OAT access identified by participants included the high cost of transportation, residing or working in remote communities and few local OAT prescribers. A variety of treatment motivations and goals that impacted OAT satisfaction are also highlighted. CONCLUSION This study demonstrates that patient satisfaction with OAT service access in a rural and coastal setting is multi-factorial and geographic proximity alone does not fully explain OAT accessibility issues in these settings. Accessibility to OAT may be improved through delivery services, expanded OAT prescribing authorisation beyond physician-only regulations, health authorities covering transportation costs and continual assurance that prescribing practices meet individuals' goals. INTRODUCTION Bien que les régions rurales soient touchées de manière disproportionnée par l'approvisionnement en drogues toxiques, on sait peu de choses sur les facteurs contextuels qui influencent l'accès au traitement par agoniste opioïde (TAO) spécifique aux résidents ruraux. La présente étude examine ces facteurs dans un contexte rural et côtier en Colombie-Britannique, au Canada. MTHODES Des méthodes qualitatives ont été utilisées pour examiner les obstacles et les facilitateurs de l'accès aux TAO. Entre juillet et octobre 2021, des entretiens semi-structurés ont été menés avec des personnes qui consomment des drogues résidant dans une communauté rurale et côtière. L'analyse thématique a été utilisée pour identifier les thèmes et sous-thèmes émergents. Les résultats ont été corroborés par l'équipe de recherche et un comité consultatif communautaire local. RSULTATS Vingt-sept (n = 27) participants ont décrit les facteurs limitants et facilitants qui ont influé sur l'accessibilité au TAO. L'accès était moins difficile lorsque la pharmacie du TAO des participants était proche, avait des heures d'ouverture prolongées ou lorsque les pharmacies offraient des services de livraison. Parmi les obstacles à l'accès au TAO mentionnés par les participants, il y avait le coût élevé du transport, le fait de résider ou de travailler dans des collectivités éloignées et la rareté des prescripteurs locaux du TAO. Les participants ont également fait état de divers objectifs et motivations liés au traitement qui ont eu une incidence sur la satisfaction à l'égard du TAO. CONCLUSION Cette étude démontre que la satisfaction des patients à l'égard de l'accès aux services du TAO en milieu rural et côtier est multifactorielle et que la proximité géographique n'explique pas à elle seule les problèmes d'accessibilité au TAO dans ces milieux. Cette accessibilité peut être améliorée par des services de livraison, l'élargissement de l'autorisation de prescrire un TAO au-delà des règlements réservés aux médecins, la prise en charge des coûts de transport par les autorités sanitaires et l'assurance continue que les pratiques de prescription répondent aux objectifs des individus.
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Affiliation(s)
- Kate Hodgson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jeanette M Bowles
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Manal Mansoor
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Edward Rooke
- The Hope to Health Research and Innovation Centre, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- First Nations Health Authority, West Vancouver, BC, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo ON, Canada
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Bortz C, Armistead I, Bonaguidi A, Coyle DT. Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209342. [PMID: 38513975 DOI: 10.1016/j.josat.2024.209342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents-safety events occurring in OTPs that are reportable to regulatory entities-across all Colorado OTPs during the COVID-19 pandemic. METHODS This study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15-December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15-December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. RESULTS OTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). CONCLUSIONS There was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.
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Affiliation(s)
- Cole Bortz
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Isaac Armistead
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
| | - Angela Bonaguidi
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - D Tyler Coyle
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA.
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Trayner KMA, Yeung A, Palmateer NE, McAuley A, Wilkinson M, Craik J, Metcalfe R, Peters E, Shepherd SJ, Gunson RN, Carter D, Sills L, Hutchinson SJ. Impact of the COVID-19 Pandemic on HIV Test Uptake Among People Who Inject Drugs in the Context of an HIV Outbreak. AIDS Behav 2024; 28:2131-2147. [PMID: 38649554 PMCID: PMC11161428 DOI: 10.1007/s10461-024-04311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
Glasgow, Scotland's largest city, has been experiencing an HIV outbreak among people who inject drugs (PWID) since 2015. A key focus of the public health response has been to increase HIV testing among those at risk of infection. Our aim was to assess the impact of COVID-19 on HIV testing among PWID in Glasgow. HIV test uptake in the last 12 months was quantified among: (1) PWID recruited in six Needle Exchange Surveillance Initiative (NESI) surveys (n = 6110); linked laboratory data for (2) people prescribed opioid agonist therapy (OAT) (n = 14,527) and (3) people hospitalised for an injecting-related hospital admission (IRHA) (n = 12,621) across four time periods: pre-outbreak (2010-2014); early-outbreak (2015-2016); ongoing-outbreak (2017-2019); and COVID-19 (2020-June 21). From the pre to ongoing period, HIV testing increased: the highest among people recruited in NESI (from 28% to 56%) and on OAT (from 17% to 54%) while the lowest was among people with an IRHA (from 15% to 42%). From the ongoing to the COVID-19 period, HIV testing decreased markedly among people prescribed OAT, from 54% to 37% (aOR 0.50, 95% CI 0.48-0.53), but increased marginally among people with an IRHA from 42% to 47% (aOR 1.19, 95% CI 1.08-1.31). In conclusion, progress in increasing testing in response to the HIV outbreak has been eroded by COVID-19. Adoption of a linked data approach could be warranted in other settings to inform efforts to eliminate HIV transmission.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
- Public Health Scotland, Glasgow, UK.
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Max Wilkinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Julie Craik
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rebecca Metcalfe
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Erica Peters
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Daniel Carter
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Laura Sills
- NHS Greater Glasgow and Clyde Addiction Services, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
- Public Health Scotland, Glasgow, UK.
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Cardamone NC, Stewart RE, Kampman KM, Marcus SC. Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder. RESEARCH SQUARE 2024:rs.3.rs-4331201. [PMID: 38746408 PMCID: PMC11092808 DOI: 10.21203/rs.3.rs-4331201/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Medications for opioid use disorder (MOUD) are among the best tools we have to combat the opioid epidemic. Yet, use of MOUD among people with opioid use disorder (OUD) remains low. Interventions to increase MOUD access in the United States have largely focused on improving organizational capacity and addressing funding barriers, yet stigma toward MOUD may inhibit uptake even where MOUD is readily available. Substance use disorder (SUD) treatment counselors likely have considerable influence on a client's choice to initiate and adhere to MOUD, but beliefs that counselors convey about MOUD in interaction with clients are understudied. The current study explores what advantages and disadvantages that SUD treatment counselors communicate about buprenorphine, methadone, and naltrexone. Methods From June to December 2021, we surveyed counselors from publicly-funded SUD treatment agencies under a municipality-wide mandate to offer MOUD to all clients with OUD. Counselors were asked to describe, in a free-response format, the most important advantages and disadvantages to communicate to their clients about taking buprenorphine, methadone, and naltrexone. Counselor responses were coded for one or more advantage and disadvantage. Results A total of 271 SUD counselors from 29 agencies completed the survey, generating 1,995 advantages and disadvantages across three types of MOUD. The most frequently reported advantage across all three types of MOUD was their ability to reduce cravings and illicit drug use. The most frequently reported disadvantage related to the potential for some types of MOUD to develop long-term medication dependence. Conclusions As the availability and variety of MOUD treatment options continue to expand, it is important that SUD counselors are equipped with evidence-based recommendations for OUD care. We identified misalignments with the MOUD-prescribing evidence base and stigmatizing language toward MOUD within counselors' responses, highlighting the potential to refine training materials for MOUD and mitigate stigmatizing beliefs.
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Affiliation(s)
| | | | | | - Steven C Marcus
- University of Pennsylvania, School of Social Policy and Practice
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Frauger E, Fouilhé N, Lacroix C, Daveluy A, Le Boisselier R, Bertin C, Revol B, Carton L, Chevalier C, Eiden C, Gibaja V, Aquizerate A, Chaouachi L, Bouquet E, Roussin A, Mallaret M, Micallef J. [Increase of overdose and deaths related to methadone during COVID-19 epidemic in 2020]. Therapie 2024; 79:297-306. [PMID: 37391322 PMCID: PMC10266982 DOI: 10.1016/j.therap.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Due to the risk of overdoses increase especially with methadone, a reinforced monitoring has been set up by the French Addictovigilance Network following the first lockdown related to coronavirus disease 2019 (COVID-19). In this context, we managed a specific study to analyze overdoses related to methadone in 2020 compared to 2019. MATERIAL AND METHODS We analyzed methadone-related overdoses which occurred in 2019 and 2020 from two sources: DRAMES program (deaths with toxicological analysis) and the French pharmacovigilance database (BNPV) (overdoses that did not lead to death). RESULTS Data from DRAMES program in 2020 show methadone as the first drug involved in deaths as well as an increase in deaths: in number (n=230 versus n=178), in proportion (41% versus 35%) and number of deaths per 1000 exposed subjects (3.4 versus 2.8). According to BNPV, the number of overdose increased in 2020 compared to 2019 (98 versus 79; i.e., 1.2-fold increase) particularly during several target periods: first lockdown, end of lockdown/summer period and second lockdown. In 2020, a higher number of cases were observed in April (n=15) and May (n=15). Overdoses and deaths occurred in subjects enrolled in treatment programs or not (naïve subjects/occasional users who obtained methadone from street market or family/friends). Overdoses resulted from different factors: overconsumption, multiple drug use with depressants drugs or cocaine, injection, consumption for sedative, recreational purposes or voluntary drug poisoning. DISCUSSION/CONCLUSION All these data show an increase of morbidity and mortality related to methadone during COVID-19 epidemic. This trend has been observed in other countries.
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Affiliation(s)
- Elisabeth Frauger
- Centre d'addictovigilance, service de pharmacologie clinique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France.
| | - Nathalie Fouilhé
- Centre d'addictovigilance, CHU de Grenoble-Alpes, 38043 Grenoble, France
| | - Clémence Lacroix
- Centre d'addictovigilance, service de pharmacologie clinique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France
| | - Amélie Daveluy
- Centre d'addictovigilance, département de pharmacologie, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
| | - Reynald Le Boisselier
- Centre d'addictovigilance, service de pharmacologie, CHU de Caen, 14033 Caen, France
| | - Célian Bertin
- Centre d'addictovigilance, service de pharmacologie médicale, CHU de Clermont-Ferrand, université Clermont Auvergne, 63003 Clermont-Ferrand, France
| | - Bruno Revol
- Centre d'addictovigilance, CHU de Grenoble-Alpes, 38043 Grenoble, France
| | - Louise Carton
- Centre d'addictovigilance, service de pharmacologie, faculté de médecine-pôle recherche, 59037 Lille, France
| | - Cécile Chevalier
- Centre d'addictovigilance, service hospitalo-universitaire de pharmacotoxicologie, hospices civils de Lyon, 69424 Lyon cedex, France
| | - Céline Eiden
- Centre d'addictovigilance, département de pharmacologie médicale et toxicologie, hôpital Lapeyronie, CHU de Montpellier, 34295 Montpellier, France
| | - Valérie Gibaja
- Centre d'addictovigilance, CHRU de Nancy, hôpital Brabois, 54511 Vandoeuvre-les-Nancy, France
| | - Aurélie Aquizerate
- Centre d'addictovigilance, service de pharmacologie clinique, institut de biologie, CHU de Nantes, 44093 Nantes, France
| | - Leila Chaouachi
- Centre d'addictovigilance, hôpital Fernand-Widal, 75475 Paris, France
| | - Emilie Bouquet
- Centre d'addictovigilance, service de pharmacologie clinique et vigilances, CHU de Poitiers, 86021 Poitiers, France
| | - Anne Roussin
- Centre d'addictovigilance, faculté de médecine, 31000 Toulouse, France
| | - Michel Mallaret
- Centre d'addictovigilance, CHU de Grenoble-Alpes, 38043 Grenoble, France
| | - Joëlle Micallef
- Centre d'addictovigilance, service de pharmacologie clinique, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France
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Qian G, Humphreys K, Goldhaber-Fiebert JD, Brandeau ML. Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis. Drug Alcohol Depend 2024; 256:111112. [PMID: 38335797 PMCID: PMC10940194 DOI: 10.1016/j.drugalcdep.2024.111112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
AIM To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM). DESIGN SETTING AND PARTICIPANTS Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM). INTERVENTION Buprenorphine and methadone treatment under NPRM. MEASUREMENTS Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs. FINDINGS For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment. CONCLUSIONS Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.
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Affiliation(s)
- Gary Qian
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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López-Castro T, Jakubowski A, Masyukova M, Peterson M, Pierz A, Kodali S, Arnsten JH, Starrels JL, Nahvi S. Loss, liberation, and agency: Patient experiences of methadone treatment at opioid treatment programs during the COVID-19 pandemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209235. [PMID: 38061636 PMCID: PMC10932891 DOI: 10.1016/j.josat.2023.209235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Despite its safety and effectiveness, methadone treatment for opioid use disorder (OUD) remains highly stigmatized, and stringent opioid treatment program (OTP) attendance requirements create barriers to retention for many patients. The COVID-19 pandemic prompted a shift in federal regulations governing methadone, including a blanket exemption permitting increased take-home doses of methadone. We studied the impact of these changes upon established patients' experiences of OTP care. METHOD We conducted semi-structured qualitative interviews with 18 OTP patients who met our criteria of having established OTP care (i.e., enrolled at the OTP for at least 12 weeks) and were administered methadone three to six days weekly prior to the March 2020 blanket exemption. Interviews centered on how COVID-19 had affected their experiences of receiving treatment at an OTP. RESULTS We identified three interconnected themes relevant to transformation of OTP care by the COVID-19 pandemic. Participants described mourning therapeutic OTP relationships and structure (1. loss), yet feeling more satisfaction with fewer in-person OTP visits (2. liberation), and appreciating more opportunities to self-direct their OUD care (3. agency). DISCUSSION Structural changes made to OTP care early in the COVID-19 pandemic resulted in loss of community and structure. Increasing the availability of take-home methadone also improved patient experience and sense of agency. Our findings join a diverse body of converging evidence in support of policy changes allowing for more flexible dosing and individualized OTP care.
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Affiliation(s)
- Teresa López-Castro
- Department of Psychology, Colin Powell School of Civic and Global Leadership, The City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Andrea Jakubowski
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Mariya Masyukova
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Project Renwal, Inc. 200 Varick Street, 9th Floor New York, NY 10014
| | - Meghan Peterson
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Department of Social Medicine, University of North Carolina - Chapel Hill School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, United States
| | - Amanda Pierz
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; The City University of New York Graduate School of Public Health and Health Policy, 55 W. 125(th) Street, New York, NY 10027, United States
| | - Sruthi Kodali
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
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Kawasaki SS, Zimmerman R, Shen C, Zgierska AE. COVID-19-related flexibility in methadone take-home doses associated with decreased attrition: Report from an opioid treatment program in central Pennsylvania. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209164. [PMID: 37730014 DOI: 10.1016/j.josat.2023.209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Pennsylvania saw a dramatic increase in take-home doses of methadone after the COVID-19 pandemic-related relaxation in regulations. We evaluated whether pandemic-initiated relaxation in take-home methadone dose regulations was associated with changes in attrition and urine drug test (UDT) results at one outpatient opioid treatment program (OTP) among adult patients treated with methadone for opioid use disorder (OUD). METHODS We analyzed aggregated, retrospective clinical practice data, using data abstracted from the OTP's electronic health record (EHR) on the number of patients treated with methadone, those allowed take-home doses, the number of take-home methadone doses dispensed, and the number and type of patient discharge ("attrition") from treatments for 12 months before (March 2019-February 2020; "pre-pandemic") and 12 months after (March 2020-February 2021; "pandemic") the regulatory changes took place. We also examined monthly aggregate data on the number of urine samples testing positive for amphetamines, cocaine, benzodiazepines or illicit opioids, and compared these findings between the pre-pandemic and pandemic periods. RESULTS Pre-pandemic, 229 patients were treated with methadone, compared to 278 patients during the pandemic period. They received 11,047 and 28,563 take-home daily-doses of methadone (p < 0.0001) during each assessment period, respectively. All-cause treatment attrition (discharge from the program for any reason) decreased from 27.1 % in the pre-pandemic to 15.5 % in the pandemic period (p < 0.001). Compared to pre-pandemic, during the pandemic period the urine toxicology testing showed reduced positivity rates for cocaine (26.4 % vs 18.9 %, p < 0.001), and oxycodone and morphine (1.8 % vs 1.1 %, p < 0.019), and increased for fentanyl (24.0 % vs 30.5 %, p < 0.007), without statistically significant changes for benzodiazepines or amphetamines. CONCLUSIONS The relaxation of regulations guiding take-home methadone doses accompanied reduced treatment attrition and favorable changes in urine toxicology results in one OTP. Allowing OTPs to apply flexible decisions regarding take-home methadone doses could improve treatment retention, outcomes, and, in turn, save lives.
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Affiliation(s)
| | | | - Chan Shen
- Penn State College of Medicine, Hershey, PA, United States
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10
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Mitchell SG, Jester J, Gryczynski J, Whitter M, Fuller D, Halsted C, Schwartz RP. Impact of COVID-19-related methadone regulatory flexibilities: views of state opioid treatment authorities and program staff. Addict Sci Clin Pract 2023; 18:61. [PMID: 37848970 PMCID: PMC10580566 DOI: 10.1186/s13722-023-00417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, federal regulations in the USA for methadone treatment of opioid use disorder (OUD) were temporarily revised to reduce clinic crowding and promote access to treatment. METHODS As part of a study seeking to implement interim methadone without routine counseling to hasten treatment access in Opioid Treatment Programs with admission delays, semi-structured qualitative interviews were conducted via Zoom with participating staff (N = 11) in six OTPs and their State Opioid Treatment Authorities (SOTAs; N = 5) responsible for overseeing the OTPs' federal regulatory compliance. Participants discussed their views on the response of OTPs in their states to the pandemic and the impact of the COVID-related regulatory flexibilities on staff, established patients, and new program applicants. Interviews were audio recorded, transcribed, and a content analysis was conducted using ATLAS.ti. RESULTS All SOTAs requested the blanket take-home exemption and supported the use of telehealth for counseling. Participants noted that these changes were more beneficial for established patients than program applicants. Established patients were able to obtain a greater number of take-homes and attend individual counseling remotely. Patients with limited resources had greater difficulty or were unable to access remote counseling. The convenience of intake through telehealth did not extend to new program applicants because the admission physical exam requirement was not waived. CONCLUSIONS The experienced reflections of SOTAs and OTP providers on methadone practice changes during the COVID-19 pandemic offer insights on SAMHSA's proposed revisions to its OTP regulations. Trial registration Clinicaltrials.gov # NCT04188977.
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Affiliation(s)
| | | | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, Baltimore, MD, 21201, USA
| | - Melanie Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Douglas Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Caroline Halsted
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Baltimore, MD, 21201, USA
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11
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Perino J, Demourgues M, Ramaroson H, Bezin J, Micallef J, Miremont-Salamé G, Frauger E, Gilleron V, Ong N, Daveluy A. Increase in hospitalisation-associated methadone intoxication in France following first COVID-19 lockdown. Public Health 2023; 223:1-6. [PMID: 37572562 DOI: 10.1016/j.puhe.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES At the beginning of the COVID-19 pandemic, the French Addictovigilance Network drew attention to the need to facilitate access to methadone while ensuring its safe use, in order to avoid the occurrence of overdoses and deaths. The objectives of the study were to assess the impact of the lockdowns on the incidence of methadone-use-related hospitalisations (MUHs) and describe the characteristics of patients and hospitalisations. STUDY DESIGN An interrupted time series using the unobserved components model was performed to predict the monthly incidence of MUHs in 2020 on the basis of previous years' data and compared with MUHs observed. Data were presented with prediction intervals (PI95%). METHODS This retrospective study was conducted on patients hospitalised in France for methadone between 2014 and 2020, using the French national database hospital discharge database. Patients' characteristics and hospitalisations were described over four periods: before lockdown, first lockdown, after first lockdown, and second lockdown. RESULTS Compared to the predictions, a higher incidence of MUH was found during the first lockdown, especially in March 2020 (66 cases vs. 51.3; PI95%: 34-65), and there was a large increase during the month following the end of the first lockdown (79 cases vs. 61; PI95%: 46-75). Coconsumptions (alcohol, cannabis, cocaine) were more frequent during the first lockdown, whereas patients aged over 30 years were more concerned thereafter. The second lockdown did not present any particularity. CONCLUSIONS The first lockdown had a significant impact on the incidence of MUHs. These results confirm the data from the reinforced national monitoring during first lockdown published in 2020, where methadone was the primary substance involved in overdoses and deaths.
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Affiliation(s)
- J Perino
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France
| | - M Demourgues
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France
| | - H Ramaroson
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - J Bezin
- University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France
| | - J Micallef
- Centre d'Addictovigilance, Aix Marseille University, AP-HM, INSERM, Institute Neuroscience System, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - G Miremont-Salamé
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France; Service de Pharmacologie Médicale, Centre d'Addictovigilance, CHU de Bordeaux, F-33000 Bordeaux, France
| | - E Frauger
- Centre d'Addictovigilance, Aix Marseille University, AP-HM, INSERM, Institute Neuroscience System, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - V Gilleron
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - N Ong
- Service d'Information Médicale, Unité de Coordination et d'Analyse de l'Information Médicale-département d'Information Médicale (UCAIM-DIM), CHU de Bordeaux, F-33000 Bordeaux, France
| | - A Daveluy
- Service de Pharmacologie Médicale, CHU de Bordeauxx, Centre de Pharmacovigilance de Bordeaux, F-33000 Bordeaux, France; University Bordeaux, INSERM, BPH, U1219, CHU de Bordeaux, F-33000 Bordeaux, France; Service de Pharmacologie Médicale, Centre d'Addictovigilance, CHU de Bordeaux, F-33000 Bordeaux, France.
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12
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Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Panwala V, Thorn E, Amiri S, Socias ME, Lutz R, Amram O. Opioid use and COVID-19: a secondary analysis of the impact of relaxation of methadone take-home dosing guidelines on use of illicit opioids. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:597-605. [PMID: 37433122 DOI: 10.1080/00952990.2023.2222336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
Background: An exemption to existing U.S. regulation of methadone maintenance therapy after the onset of the COVID-19 pandemic permitted increased take-home doses beginning March 2020.Objectives: We assessed the impact of this exemption on opioid use.Methods: A pre/post study of 187 clients recruited from an OTP who completed a survey and consented to share their urine drug testing (UDT) data. Use of fentanyl, morphine, hydromorphone, codeine, and heroin was assessed via UDT. Receipt of take-home methadone doses was assessed from clinic records for 142 working days pre- and post-COVID exemption. Analysis was conducted using a linear regression model to assess the association between increased take-home doses and use of illicit opioids.Results: In the pre- vs. post-COVID-19 SAMHSA exemption periods, 26.2% vs. 36.3% of UDTs were positive for 6-acetylmorphine respectively, 32.6% vs. 40.6% positive for codeine, 34.2% vs 44.2% positive for hydromorphone, 39.5% vs. 48.1% positive for morphine, 8.0% vs. 14.4% positive for fentanyl (p-value < .001). However, in the unadjusted descriptive data, when grouped by change in substance use, those clients who experienced a decrease in the use of morphine, codeine, and heroin post-COVID-19 were given significantly more take-home doses than the groups that had no change or an increase in the use of these substances. In the adjusted model, there was no significant relationship between change in opioid use and increased receipt of take-home methadone doses.Conclusions: Although take-home doses post-COVID-19 nearly doubled, this increase was not associated with a significant change in use of illicit opioids.
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Affiliation(s)
- Victoria Panwala
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Emily Thorn
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Lutz
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Panwala V, Joudrey P, Kowalski M, Bach P, Amram O. Changes to methadone maintenance therapy in the United States, Canada, and Australia during the COVID-19 pandemic: A narrative review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209086. [PMID: 37270103 PMCID: PMC10232933 DOI: 10.1016/j.josat.2023.209086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/08/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, countries across the world made adaptations to policies regulating the provision of methadone maintenance therapy (MMT) to facilitate social distancing for health care providers and people in treatment. Many countries issued guidance about increasing take-home methadone doses after the onset of the pandemic. METHODS In this review, we compare the regulation of MMT prior to the pandemic in the United States, Canada, and Australia, analyze changes to treatment policy in the context of COVID-19, and review emerging data on treatment outcomes. RESULTS The United States only permits the prescription and disbursement of methadone for MMT treatment at federally designated opioid treatment programs (OTPs). Conversely, Australia and Canada operate on a community pharmacy-based distribution model, where patients can access methadone doses either in participating pharmacies or in some methadone clinics. CONCLUSION Given reports of similar treatment outcomes and increased patient satisfaction since the pandemic-related policy changes, some changes including increased receipt of take-home doses should be considered for incorporation into post-pandemic treatment policies and regulations.
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Affiliation(s)
- Victoria Panwala
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Paul Joudrey
- Center for Research on Health Care, University of Pittsburgh, PA, USA
| | - Melanie Kowalski
- Mental Health and Wellbeing Division, Department of Health, Victoria, Australia
| | - Paxton Bach
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, BC, Canada
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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15
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Braun HM, Potee RA. Individualizing methadone treatment with split dosing: An underutilized tool. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209096. [PMID: 37301287 DOI: 10.1016/j.josat.2023.209096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
Methadone's long half-life typically allows for once daily dosing. However, a growing body of evidence and clinical experience shows that some patients may benefit from twice-daily ("split") dosing to produce more stable symptoms and minimize side effects, independent of serum peak-to-trough levels. Concerns regarding split dosing typically center on diversion and poor adherence and must be taken seriously. However, policy changes during COVID-19 demonstrate that the rigidity historically applied to methadone may be unnecessarily stringent. Given clinical advances and policy updates, we believe clinicians should weigh the risks and benefits of this underutilized tool for select patients, as we await the evidence-based recommendations our patients deserve.
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Affiliation(s)
- Hannan M Braun
- Division of General Internal Medicine, Denver Health and Hospital Authority, Denver, CO, United States of America; Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Ruth A Potee
- Department of Family Medicine, Baystate Franklin Medical Center, Greenfield, MA, United States of America.
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16
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Nosyk B, Kurz M, Guerra-Alejos BC, Piske M, Dale L, Min JE. Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014-20. Addiction 2023; 118:1376-1380. [PMID: 36772838 PMCID: PMC11025638 DOI: 10.1111/add.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND AIM While daily witnessed opioid agonist treatment (OAT) ingestion is common in British Columbia (BC), Canada, and elsewhere, sparse evidence supports this resource-intensive practice. Many settings across North America relaxed restrictions for take-home dosing during the COVID-19 pandemic and have reported consistent or improved patient outcomes. This study measured excess expenditures attributed to daily witnessed pharmacy dispensing compared with weekly or biweekly dispensation schedules. DESIGN, SETTING AND PARTICIPANTS This study was a population-level retrospective analysis. We included all methadone, buprenorphine/naloxone and slow-release oral morphine dispensations in BC from 1 January 2014 to 30 December 2020. A total of 24 357 107 OAT dispensations among 51 195 unique individuals with 122 793 person-years of follow-up were included during the study period. MEASUREMENTS Total expenditures for each person-week of OAT with an estimated expenditure under two scenarios are as follows: (1) a weekly dispensation scenario and (2) a biweekly dispensation scenario. FINDINGS We estimated excess expenditures attributable to current dispensing practices of between $38 million (2014) and $47.4 million (2018) compared with a hypothetical weekly dispensing schedule, and $43.9 million (2014) to $54.9 million (2018) compared with biweekly dispensing. The majority of these expenditures (58-64%) were attributed to pharmacy dispensing fees ($23 million in 2014 to $30 million in 2018 compared with weekly dispensing; $26.6 million in 2014 to $34.7 million in 2018 compared with biweekly dispensing). CONCLUSION Daily witnessed opioid agonist treatment ingestion results in more than $30 million in excess expenditures annually in the province of British Columbia, Canada compared with the costs of weekly or biweekly dispensation schedules.
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Affiliation(s)
- Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
| | - Megan Kurz
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; Vancouver, British Columbia, Canada
| | | | - Micah Piske
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; Vancouver, British Columbia, Canada
| | - Laura Dale
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; Vancouver, British Columbia, Canada
| | - Jeong Eun Min
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; Vancouver, British Columbia, Canada
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Thakrar AP, Pytell JD, Stoller KB, Walters V, Weiss RD, Chander G. Transitioning off methadone: A qualitative study exploring why patients discontinue methadone treatment for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209055. [PMID: 37088398 PMCID: PMC10330232 DOI: 10.1016/j.josat.2023.209055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Patients who discontinue methadone for opioid use disorder are at increased risk of overdose and death. We know little about how patients make the decision to stop treatment. This study explored reasons why patients discontinue methadone treatment. METHODS We conducted 20 individual semi-structured patient interviews and two staff focus groups, each with five participants, at two opioid treatment programs in Baltimore, MD, in the United States from June 2021 to May 2022. Patient interviews and staff focus groups covered three domains: 1) reasons why patients may want to discontinue methadone; 2) perspectives about the ideal length of methadone treatment; and 3) changes that could improve retention. We used a modified grounded theory approach to code interviews, identify emergent themes, and develop a conceptual model. RESULTS We identified three themes related to patients' internal relationships to methadone: patients (1) viewed methadone as a bridge to opioid-free recovery, (2) believed that long-term methadone damages the body, and (3) felt that methadone increases craving for cocaine; and three themes related to their external relationships with opioid treatment programs and society at large: patients (4) viewed daily dosing as burdensome, (5) feared methadone inaccessibility could trigger relapse, and (6) experienced stigma from friends, family, and peers. Patients with internal reasons planned to stop as soon as possible and asked for education about perceived side effects and treatment for cocaine craving to promote retention. Patients with external reasons were willing to continue for longer and asked for adaptive take-home policies and reduced societal stigma around methadone. CONCLUSIONS Patients want to discontinue methadone either because of their internal relationship to methadone and its real or perceived side effects, or because of their external experiences with opioid treatment programs and societal stigma of methadone. To improve retention, clinical and policy changes should consider responses to both of these categories of reasons.
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Affiliation(s)
- Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, United States of America; Leonard Davis Institute of Health Economics University of Pennsylvania, Philadelphia, United States of America.
| | - Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America.
| | - Kenneth B Stoller
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States of America.
| | | | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Geetanjali Chander
- Department of Medicine, University of Washington, United States of America.
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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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Conway A, Marshall AD, Crawford S, Hayllar J, Grebely J, Treloar C. Deimplementation in the provision of opioid agonist treatment to achieve equity of care for people engaged in treatment: a qualitative study. Implement Sci 2023; 18:22. [PMID: 37296448 DOI: 10.1186/s13012-023-01281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Deimplementation, the removal or reduction of potentially hazardous approaches to care, is key to progressing social equity in health. While the benefits of opioid agonist treatment (OAT) are well-evidenced, wide variability in the provision of treatment attenuates positive outcomes. During the COVID-19 pandemic, OAT services deimplemented aspects of provision which had long been central to treatment in Australia; supervised dosing, urine drug screening, and frequent in-person attendance for review. This analysis explored how providers considered social inequity in health of patients in the deimplementation of restrictive OAT provision during the COVID-19 pandemic. METHODS Between August and December 2020, semi-structured interviews were conducted with 29 OAT providers in Australia. Codes relating to the social determinants of client retention in OAT were clustered according to how providers considered deimplementation in relation to social inequities. Normalisation Process Theory was then used to analyse the clusters in relation to how providers understood their work during the COVID-19 pandemic as responding to systemic issues that condition OAT access. RESULTS We explored four overarching themes based on constructs from Normalisation Process Theory: adaptive execution, cognitive participation, normative restructuring, and sustainment. Accounts of adaptive execution demonstrated tensions between providers' conceptions of equity and patient autonomy. Cognitive participation and normative restructuring were integral to the workability of rapid and drastic changes within the OAT services. Key transformative actors included communities of practice and "thought leaders" who had long supported deimplementation for more humane care. At this early stage of the pandemic, providers had already begun to consider how this period could inform sustainment of deimplementation. When considering a future, post-pandemic period, several providers expressed discomfort at operating with "evidence-enough" and called for narrowly defined types of data on adverse events (e.g. overdose) and expert consensus on takeaway doses. CONCLUSIONS The possibilities for achieving social equity in health are limited by the divergent treatment goals of providers and people receiving OAT. Sustained and equitable deimplementation of obtrusive aspects of OAT provision require co-created treatment goals, patient-centred monitoring and evaluation, and access to a supportive community of practice for providers.
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Affiliation(s)
- Anna Conway
- The Kirby Institute, UNSW, Sydney, Australia.
- Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Alison D Marshall
- The Kirby Institute, UNSW, Sydney, Australia
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | | | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Australia
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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20
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Harris RA, Long JA, Bao Y, Mandell DS. Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses. JAMA HEALTH FORUM 2023; 4:e231235. [PMID: 37294585 PMCID: PMC10257097 DOI: 10.1001/jamahealthforum.2023.1235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. Objective To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Design, Setting, and Participants Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. Exposure On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Main Outcome Measures Monthly methadone-involved overdose deaths. Results From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). Conclusions and Relevance In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - David S. Mandell
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Wyse JJ, Shull S, Lindner S, Morasco BJ, Gordon AJ, Carlson KF, Korthuis PT, Ono SS, Liberto JG, Lovejoy TI. Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities. J Gen Intern Med 2023; 38:1871-1876. [PMID: 36690913 PMCID: PMC9870655 DOI: 10.1007/s11606-023-08027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND For patients with opioid use disorder (OUD), medications for OUD (MOUD) reduce morbidity, mortality, and return to use. Nevertheless, a minority of patients receive MOUD, and underutilization is pronounced among rural patients. OBJECTIVE While Veterans Health Administration (VHA) initiatives have improved MOUD access overall, it is unknown whether access has improved in rural VA health systems specifically. How "Community Care," healthcare paid for by VHA but received from non-VA providers, has affected rural access is also unknown. DESIGN Data for this observational study were drawn from the VHA Corporate Data Warehouse. Facility rurality was defined by rural-urban commuting area code of the primary medical center. International Classification of Diseases codes identified patients with OUD within each year, 2015-2020. We included MOUD (buprenorphine, methadone, extended-release naltrexone) received from VHA or paid for by VHA but received at non-VA facilities through Community Care. We calculated average yearly MOUD receipt; linear regression of outcomes on study years identified trends; an interaction between year and rural status evaluated trend differences over time. PARTICIPANTS All 129 VHA Health Systems, a designation that encompasses one or more medical centers and their affiliated community-based outpatient clinics MAIN MEASURES: The average proportion of patients diagnosed with OUD that receive MOUD within rural versus urban VHA health care systems. KEY RESULTS From 2015 to 2020, MOUD access increased substantially: the average proportion of patients receiving MOUD increased from 34.6 to 48.9%, with a similar proportion of patients treated with MOUD in rural and urban systems in all years. Overall, a small proportion (1.8%) of MOUD was provided via Community Care, and Community Care did not disproportionately benefit rural health systems. CONCLUSIONS Strategies utilized by VHA could inform other health care systems seeking to ensure that, regardless of geographic location, all patients are able to access MOUD.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA.
- School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR, 97239, USA.
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Stephan Lindner
- School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR, 97239, USA
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Center for Health Systems Effectiveness, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
- School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR, 97239, USA
| | - P Todd Korthuis
- School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR, 97239, USA
- Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- VA Office of Rural Health, Veterans Rural Health Resource Center, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Joseph G Liberto
- Office of Mental Health and Suicide Prevention, VA Central Office (VACO), U.S. Department of Veterans Affairs, 1100 1st Street NE, Washington, D.C, 20002, USA
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St, Baltimore, MD, 21201, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- VA Office of Rural Health, Veterans Rural Health Resource Center, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA
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22
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Darnton JB, Bhatraju EP, Beima-Sofie K, Michaels A, Hallgren KA, Soth S, Grekin P, Woolworth S, Tsui JI. "Sign Me Up": a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic. Addict Sci Clin Pract 2023; 18:21. [PMID: 36991506 PMCID: PMC10052285 DOI: 10.1186/s13722-023-00372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)-a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. METHODS We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. RESULTS We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. CONCLUSIONS VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities.
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Affiliation(s)
- James B Darnton
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Elenore P Bhatraju
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Alyssa Michaels
- Division of HIV, ID, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Paul Grekin
- Evergreen Treatment Services, Seattle, WA, 98134, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | | | - Judith I Tsui
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA.
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23
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Brothers S, Palayew A, Simon C, Coulter A, Strichartz K, Voyles N, Vincent L. Patient experiences of methadone treatment changes during the first wave of COVID-19: a national community-driven survey. Harm Reduct J 2023; 20:31. [PMID: 36894968 PMCID: PMC9996563 DOI: 10.1186/s12954-023-00756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND During COVID-19, the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed Methadone Maintenance Treatment (MMT) programs to relax in-person MMT requirements to reduce COVID-19 exposure. This study examines patient-reported changes to in-person methadone clinic attendance requirements during COVID-19. METHODS From June 7, 2020, to July 15, 2020, a convenience sample of methadone patients (N = 392) were recruited in collaboration with National Survivors Union (NSU) in 43 states and Washington D.C. through social media (Facebook, Reddit, Twitter, and Web site pop-ups). The community-driven research (CDR) online survey collected information on how patient take-home methadone dosing and in-person drug testing, counseling, and clinic visit frequency changed prior to COVID-19 (before March 2020) to during COVID-19 (June and July 2020). RESULTS During the study time period, the percentage of respondents receiving at least 14 days of take-home doses increased from 22 to 53%, while the percentage receiving one or no take-home doses decreased from 22.4% before COVID-19 to 10.2% during COVID-19. In-person counseling attendance decreased from 82.9% to 19.4%. While only 3.3% of respondents accessed counseling through telehealth before COVID-19, this percentage increased to 61.7% during COVID-19. Many respondents (41.3%) reported visiting their clinics in person once a week or more during COVID-19. CONCLUSIONS During the first wave of COVID-19, methadone patients report decreased in-person clinic attendance and increased take-home doses and use of telehealth for counseling services. However, respondents reported considerable variations, and many were still required to make frequent in-person clinic visits, which put patients at risk of COVID-19 exposure. Relaxations of MMT in-person requirements during COVID-19 should be consistently implemented and made permanent, and patient experiences of these changes should be explored further.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Pennsylvania State University, University Park, USA.
| | - Adam Palayew
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Caty Simon
- Methadone Advocacy Working Group, National Survivors Union, Greensboro, NC, USA.,NC Survivors Union, Greensboro, NC, USA.,Whose Corner Is It Anyway, Holyoke, MA, USA
| | - Abby Coulter
- Methadone Advocacy Working Group, National Survivors Union, Greensboro, NC, USA
| | - Knina Strichartz
- Methadone Advocacy Working Group, National Survivors Union, Greensboro, NC, USA
| | - Nick Voyles
- Methadone Advocacy Working Group, National Survivors Union, Greensboro, NC, USA
| | - Louise Vincent
- Methadone Advocacy Working Group, National Survivors Union, Greensboro, NC, USA.,NC Survivors Union, Greensboro, NC, USA
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Krawczyk N, Rivera BD, Levin E, Dooling BCE. Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy. Lancet Public Health 2023; 8:e238-e246. [PMID: 36841564 PMCID: PMC9949855 DOI: 10.1016/s2468-2667(23)00023-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/25/2023]
Abstract
As the USA faces a worsening overdose crisis, improving access to evidence-based treatment for opioid use disorder (OUD) remains a policy priority. Federal regulatory changes in response to the COVID-19 pandemic substantially expanded flexibilities on take-home doses for methadone treatment for OUD. These changes have fuelled questions about the effect of new regulations on OUD outcomes and the potential effect on health of permanently integrating these flexibilities into treatment policy going forward. To aide US policy makers as they consider implementing permanent methadone regulatory changes, we conducted a review synthesising peer-reviewed research on the effect of the flexibilities of methadone take-home policies introduced during COVID-19 on methadone programme operations, OUD patient and provider experiences, and patient health outcomes. We interpret the findings in the context of the federal rule-making process and discuss avenues by which these findings can be incorporated and implemented into US policies on substance use treatment going forward.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, Center for Opioid Epidemiology and Policy (COEP), NYU Grossman School of Medicine, New York, NY, USA.
| | - Bianca D Rivera
- Department of Population Health, Center for Opioid Epidemiology and Policy (COEP), NYU Grossman School of Medicine, New York, NY, USA
| | - Emily Levin
- Regulatory Studies Center, The George Washington University, Washington, DC, USA
| | - Bridget C E Dooling
- Regulatory Studies Center, The George Washington University, Washington, DC, USA
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Kaufman DE, Kennalley AL, McCall KL, Piper BJ. Examination of methadone involved overdoses during the COVID-19 pandemic. Forensic Sci Int 2023; 344:111579. [PMID: 36739850 PMCID: PMC9886385 DOI: 10.1016/j.forsciint.2023.111579] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The US opioid overdose epidemic continues to escalate. The restrictions on methadone availability including take-home dosing were loosened during the COVID-19 pandemic although there have been concerns about the high street value of diverted methadone. This report examined how fatal overdoses involving methadone have changed over the past two-decades including during the pandemic. METHODS The CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER) was used to find the unintentional methadone related overdose death rate from 1999 to 2020. Unintentional methadone deaths were defined using the ICD X40-44 codes with only data for methadone (T40.3). Data from the DEA's Automation of Reports and Consolidated Orders System (ARCOS) on methadone overall use, opioid treatment programs use, and pain management use was gathered for all states for 2020 and corrected for population. RESULTS There have been dynamic changes over the past two-decades in methadone overdoses. Overdoses increased from 1999 (0.9/million) to 2007 (15.9) and declined until 2019 (6.5). Overdoses in 2020 (9.6) were 48.1% higher than in 2019 (t(50) = 3.05, p < .005). The state level correlations between overall methadone use (r(49) = +0.75, p < .001), and opioid treatment program use (r(49) = +0.77, p < .001) with overdoses were positive, strong, and statistically significant. However, methadone use for pain treatment was not associated with methadone overdoses (r(49) = -0.08). CONCLUSIONS Overdoses involving methadone significantly increased by 48.1% in 2020 relative to 2019. Policy changes that were implemented following the COVID-19 pandemic involving methadone take-homes may warrant further study before they are made permanent.
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Affiliation(s)
| | - Amy L Kennalley
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Kenneth L McCall
- University of New England, Portland, ME, USA; Binghamton University, NY, USA
| | - Brian J Piper
- Touro College of Osteopathic Medicine, Middletown, NY, USA; Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA.
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Parker DG, Zentner D, Burack JA, Wendt DC. The impact of the COVID-19 pandemic on medications for opioid use disorder services in the U.S. and Canada: a scoping review. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2181147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel G. Parker
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Daysi Zentner
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Jacob A. Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dennis C. Wendt
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Abidogun TM, Cole TO, Massey E, Kleinman M, Greenblatt AD, Seitz-Brown CJ, Magidson JF, Belcher AM. Patient experiences of COVID-19-induced changes to methadone treatment in a large community-based opioid treatment program in Baltimore. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208946. [PMID: 36880915 PMCID: PMC9822549 DOI: 10.1016/j.josat.2022.208946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 12/30/2022] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Following the March 2020 federal declaration of a COVID-19 public health emergency, in line with recommendations for social distancing and decreased congregation, federal agencies issued sweeping regulation changes to facilitate access to medications for opioid use disorder (MOUD) treatment. These changes allowed patients new to treatment to receive multiple days of take-home medications (THM) and to use remote technology for treatment encounters-allowances that previously had been reserved exclusively for "stable" patients who met minimum adherence and time-in-treatment criteria. The impact of these changes on low-income, minoritized patients (frequently the largest recipients of opioid treatment program [OTP]-based addiction care), however, is not well characterized. We aimed to explore the experiences of patients who were enrolled in treatment prior to COVID-19 OTP regulation changes, with the goal of understanding patients' perceptions of the impact of these changes on treatment. METHODS This study included semistructured, qualitative interviews with 28 patients. We used a purposeful sampling method to recruit individuals who were active in treatment just before COVID-19-related policy changes went into effect, and who were still in treatment several months later. To ensure a diverse array of perspectives, we interviewed individuals who either had or had not experienced challenges with methadone medication adherence from 3/24/21 to 6/8/21, approximately 12-15 months following the onset of COVID-19. Interviews were transcribed and coded using thematic analysis. RESULTS Participants were majority male (57 %), Black/African American (57 %), with a mean age of 50.1 (SD = 9.3). Fifty percent received THM prior to COVID-19, which increased to 93 % during the pandemic. COVID-19 program changes had mixed effects on treatment and recovery experiences. Themes identified convenience, safety, and employment as reasons for preferring THM. Challenges included difficulty with managing/storing medications, experiencing isolation, and concern about relapse. Furthermore, some participants reported that telebehavioral health encounters felt less personal. CONCLUSIONS Policymakers should consider patients' perspectives to foster a more patient-centered approach to methadone dosing that is safe, flexible, and accommodating to a diverse array of patients' needs. Additionally, technical support should be provided to OTPs to ensure interpersonal connections are maintained in the patient-provider relationship beyond the pandemic.
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Affiliation(s)
- Tolulope M Abidogun
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Thomas O Cole
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - Ebonie Massey
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Mary Kleinman
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Aaron D Greenblatt
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America.
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28
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Englander H, Gregg J, Levander XA. Envisioning Minimally Disruptive Opioid Use Disorder Care. J Gen Intern Med 2023; 38:799-803. [PMID: 36401107 PMCID: PMC9676870 DOI: 10.1007/s11606-022-07939-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
Most people who need and want treatment for opioid addiction cannot access it. Among those who do get treatment, only a fraction receive evidence-based, life-saving medications for opioid use disorder (MOUD). MOUD access is not simply a matter of needing more clinicians or expanding existing treatment capacity. Instead, many facets of our health systems and policies create unwarranted, inflexible, and punitive practices that create life-threatening barriers to care. In the USA, opioid use disorder care is maximally disruptive. Minimally disruptive medicine (MDM) is a framework that focuses on achieving patient goals while imposing the smallest possible burden on patients' lives. Using MDM framing, we highlight how current medical practices and policies worsen the burden of treatment and illness, compound life demands, and strain resources. We then offer suggestions for programmatic and policy changes that would reduce disruption to the lives of those seeking care, improve health care quality and delivery, begin to address disparities and inequities, and save lives.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. .,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | | | - Ximena A Levander
- Section of Addiction Medicine in Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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29
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Leventelis C, Katsouli A, Stavropoulos V, Karasavvidou A, Papadopoulos P, Barmpas PT, Tasoulis S, Veskoukis AS, Tsironi M. The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:76-94. [PMID: 36793483 PMCID: PMC9893127 DOI: 10.1177/14550725221135574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment (MAT) programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. The aim of this study was to develop and validate the PANdemic Medication-Assisted Treatment Questionnaire (PANMAT/Q) to address the pandemic effect on the management and administration of MAT. In total, 463 patients under ΜΑΤ participated. Our findings indicate that PANMAT/Q has been successfully validated exerting reliability and validity. It can be completed within approximately 5 min, and its implementation in research settings is advocated. PANMAT/Q could serve as a useful tool to identify the needs of patients under MAT being at high risk of relapse and overdose.
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Affiliation(s)
- Christonikos Leventelis
- Christonikos Leventelis, Toxicology Scientist, Department of Nursing, University of Peloponnese, Tripoli, 22100, Greece.
;
| | | | | | | | | | - Petros T. Barmpas
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Sotiris Tasoulis
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | | | - Maria Tsironi
- Nursing Department, University of Peloponnese, Panarcadian Hospital Erythrou, Tripoli, Greece
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30
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Kleinman RA, Sanches M. Methadone-involved overdose deaths in the United States before and during the COVID-19 pandemic. Drug Alcohol Depend 2023; 242:109703. [PMID: 36516551 PMCID: PMC9674402 DOI: 10.1016/j.drugalcdep.2022.109703] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few studies have characterized methadone-involved overdose deaths in the US since 2014 despite changing patterns of opioid use, the onset of the COVID-19 pandemic, and changes to take-home dose guidance in opioid treatment programs (OTPs) in March 2020. METHODS Data on monthly overdose deaths in the US from January 1, 2007 to March 31, 2021 were obtained through CDC WONDER. Interrupted time series models were used to assess for changes in series levels starting in April 2020. Analyses were stratified by involvement of synthetic opioids in overdose deaths. RESULTS An increase in methadone-involved overdoses of 105.4 deaths per month (95 % CI: 73.8-137.0) occurred starting in April 2020 compared with prior trends (p < 0.001). Trends in methadone-involved overdose deaths showed a step increase starting in April 2020 both with (54.2 deaths per month; 95 % CI: 39.4-68.9) and without (51.7 deaths per month; 95 % CI: 23.4-78.0) synthetic opioid involvement (p < 0.001 for both). Among overdose deaths without synthetic opioids, the increase in methadone-involved overdose deaths accounted for 26.5 % of the increase between the 12-month periods before and after March 2020. The relative percentage increase in methadone-involved overdose deaths, both with and without synthetic opioid co-involvement, was highest among Hispanic and non-Hispanic Black individuals. CONCLUSIONS Methadone-involved overdose deaths, both with and without other synthetic opioid co-involvement, increased during the 12-month period after March 2020, compared with prior trends. These results provide a cautionary addition to previous findings of no or limited methadone-related harms after the US regulatory changes during the COVID-19 pandemic.
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Affiliation(s)
- Robert A Kleinman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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31
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Müllerschön B, Stöver H. Nutzen und zukünftige Relevanz der Corona-bedingt befristeten
Änderungen in der Substitution in Deutschland. SUCHTTHERAPIE 2022. [DOI: 10.1055/a-1968-5655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Zusammenfassung
Ziel der Studie Die COVID-19-Pandmie hat die Substitutionsbehandlung vor
große Herausforderungen gestellt. An der oft als restriktiv angesehenen
Rechtsgrundlage (BtM-VV) wurden befristete Änderungen vorgenommen, um
Behandler:innen mehr Spielraum bei der Gestaltung der Therapien zu
gewährleisten. Weitreichende Flexibilisierungen wurden in den Bereichen
Take-Home-Verschreibungen, konsiliarische Behandlung und Delegation vorgenommen.
Zusätzlich wurden neue Vergütungsmöglichkeiten im
Einheitlichen Bewertungsmaßstab (EBM) geschaffen. Durch
leitfadengestützte Interviews mit substituierenden Ärzt:innen
wurde eine Evaluation der befristeten BtM-VV- und EBM- Änderungen
vorgenommen.
Methodik Im Jahr 2021 wurden 16 qualitative Interviews mit
substituierenden Ärzt:innen aus zehn verschiedenen Bundesländern
in Deutschland geführt. Die Interviewten wurden zu ihren Erfahrungen mit
den Corona-bedingt befristeten BtM-VV- und EBM-Änderungen befragt. Im
Fokus stand dabei, ob die temporären Flexibilitäten dauerhaft in
die post-pandemische Praxis übernommen werden sollten. Der
Interviewleitfaden enthielt zusätzlich Fragen zu strukturellen
Barrieren, Nachwuchsmangel und Stigmatisierung.
Ergebnisse Zur Kontaktreduzierung verlängerte die Mehrheit der
Ärzt:innen Take-Home-Rezepte. In Folge machte nur eine befragte Person
ausschließlich negative Erfahrungen. Insgesamt berichteten die
Ärzt:innen über keine und/oder positive
Veränderungen im Therapieverlauf. Behandler:innen nutzten die meisten
der befristeten Rechts- und Vergütungsänderungen in der
Behandlungsgestaltung. Sie sprachen sich überwiegend für eine
Übernahme der befristeten Regelungen in den post-pandemisch Regelbetrieb
aus. Kontrovers wurden die Änderungen bezüglich der Aufhebung
der Kapazitätsgrenze bei der Konsiliarregelung und der erweiterten
Delegation diskutiert.
Schlussfolgerung Die Ergebnisse sprechen für die Übernahme
der befristeten BtM-VV- und EBM-Änderungen in den post-pandemischen
Regelbetrieb. Die Flexibilisierungen erleichtern die Anpassung der Therapie an
individuelle Umstände der Behandler:innen und Patient:innen. Dies
könnte dazu beitragen, die derzeitigen Versorgungsengpässe zu
entschärfen und mehr Menschen mit Opioid-Abhängigkeit eine
qualitativ hochwertige Substitutionstherapie anbieten zu können. Eine
Untersuchung und Beseitigung struktureller Barrieren darf bei der Ein- bzw.
Fortführung erweiterter Handlungsspielräume nicht vergessen
werden. Da gesetzliche Flexibilisierungen zwangsläufig mehr
Verantwortung auf die einzelnen Ärzt:innen übertragen, sollte
eine verstärkte Unterstützung durch Schulungen und Vernetzung
angeboten werden.
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Affiliation(s)
- Babette Müllerschön
- Institut für Geschichte der Medizin der
Justus-Liebig-Universität Gießen
- Institut für Suchtforschung der Frankfurt University of Applied
Sciences
| | - Heino Stöver
- Institut für Suchtforschung der Frankfurt University of Applied
Sciences
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32
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Feder KA, Choi J, Schluth CG, Hayashi K, DeBeck K, Milloy MJ, Kirk GD, Mehta SH, Kipke M, Moore RD, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Genberg BL. Factors associated with self-reported avoidance of harm reduction services during the COVID-19 pandemic by people who use drugs in five cities in the United States and Canada. Drug Alcohol Depend 2022; 241:109544. [PMID: 35779987 PMCID: PMC9225925 DOI: 10.1016/j.drugalcdep.2022.109544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study examines individual-level factors associated with avoiding two important health services for people who use drugs-medications for treatment of opioid use disorder and syringe service programs-during the first year of the COVID-19 pandemic. METHODS Data come from two subsamples of people who use drugs who were active participants in one of nine cohort studies in Vancouver, British Columbia; Baltimore, Maryland; Los Angeles, California; Chicago, Illinois; and Miami, Florida. Participants were interviewed remotely about COVID-19-associated disruptions to healthcare. We estimated the association of demographic, social, and health factors with each outcome using logistic regression among 702 participants (medication analysis) and 304 participants (syringe service analysis.) Analyses were repeated, stratified by city of residence, to examine geographic variation in risk. RESULTS There were large differences between cities in the prevalence of avoiding picking up medications for opioid use disorder, with almost no avoidance in Vancouver (3%) and nearly universal avoidance in Los Angeles, Chicago, and Miami (>90%). After accounting for between-city differences, no individual factors were associated with avoiding picking up medications. The only factor significantly associated with avoiding syringe service programs was higher levels of self-reported worry about COVID-19. CONCLUSION During the first year of the COVID-19 pandemic, geographic differences in service and policy contexts likely influenced avoidance of health and harm reduction services by people who use drugs in the United States and Canada more than individual differences between people.
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Affiliation(s)
- Kenneth A. Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States,Correspondence to: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21211, USA
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Catherine G. Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Michael-John Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, Columbia
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States,Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Michele Kipke
- Keck School of Medicine, University of Southern California, United States
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Marianna K. Baum
- Stemple School of Public Health, Florida International University, United States
| | - Steven Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, USA
| | | | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
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33
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Hallgren KA, Darnton J, Soth S, Blalock KL, Michaels A, Grekin P, Saxon AJ, Woolworth S, Tsui JI. Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic. J Subst Abuse Treat 2022; 143:108896. [PMID: 36215911 PMCID: PMC9531364 DOI: 10.1016/j.jsat.2022.108896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/20/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Methadone is one of the most utilized treatments for opioid use disorder. However, requirements for observing methadone dosing can impose barriers to patients and increase risk for respiratory illness transmission (e.g., COVID-19). Video observation of methadone dosing at home could allow opioid treatment programs (OTPs) to offer more take-home doses while ensuring patient safety through remote observation of ingestion. METHODS Between April and August 2020, a clinical pilot program of video observation of methadone take-home dosing via smartphone was conducted within a multisite OTP agency. Participating patients completed a COVID-19 symptom screener and submitted video recordings of themselves ingesting all methadone take-home doses. Patients who followed these procedures for a two-week trial period could continue participating in the full pilot program and potentially receive more take-home doses. This retrospective observational study characterizes patient engagement and compares clinical outcomes with matched controls. RESULTS Of 44 patients who initiated the two-week trial, 33 (75 %) were successful and continued participating in the full pilot program. Twenty full pilot participants (61 %) received increased take-home doses. Full pilot participants had more days with observed dosing over a 60-day period than matched controls (mean = 53.2 vs. 16.6 days, respectively). Clinical outcomes were similar between pilot participants and matched controls. CONCLUSIONS Video observation of methadone take-home dosing implemented during the COVID-19 pandemic was feasible. This model has the potential to enhance safety by increasing rates of observed methadone dosing and reducing infection risks and barriers associated with relying solely on face-to-face observation of methadone dosing.
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Affiliation(s)
- Kevin A. Hallgren
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Corresponding author at: Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Box 356560, 1959 NE Pacific St., Seattle, WA 98195, United States
| | - James Darnton
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Kendra L. Blalock
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Alyssa Michaels
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Paul Grekin
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Andrew J. Saxon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - Steve Woolworth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Judith I. Tsui
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
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Rahimi-Ardabili H, Feng X, Nguyen PY, Astell-Burt T. Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12835. [PMID: 36232135 PMCID: PMC9564909 DOI: 10.3390/ijerph191912835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.
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Affiliation(s)
- Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
| | - Phi-Yen Nguyen
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
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35
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Jones CM, Compton WM, Han B, Baldwin G, Volkow ND. Methadone-Involved Overdose Deaths in the US Before and After Federal Policy Changes Expanding Take-Home Methadone Doses From Opioid Treatment Programs. JAMA Psychiatry 2022; 79:932-934. [PMID: 35830198 PMCID: PMC9280608 DOI: 10.1001/jamapsychiatry.2022.1776] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This observational study assesses whether methadone-involved overdose deaths decreased when opioid treatment programs take-home policies changed during the COVID-19 pandemic.
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Affiliation(s)
- Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant Baldwin
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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36
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Williams AR, Mauro CM, Feng T, Wilson A, Cruz A, Olfson M, Crystal S, Samples H, Chiodo L. Non-prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder. J Subst Abuse Treat 2022; 139:108770. [PMID: 35337715 PMCID: PMC9187606 DOI: 10.1016/j.jsat.2022.108770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non-prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. METHODS The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015-2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. RESULTS Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89). CONCLUSION NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
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Affiliation(s)
- Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America.
| | - Christine M Mauro
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, United States of America
| | - Tianshu Feng
- Research Foundation for Mental Hygiene, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Amanda Wilson
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America
| | - Angelo Cruz
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Hillary Samples
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Lisa Chiodo
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America; University of Massachusetts Amherst, School of Nursing, 651 N Pleasant St, Amherst, MA 01003, United States of America
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Vo AT, Patton T, Peacock A, Larney S, Borquez A. Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148883. [PMID: 35886734 PMCID: PMC9317093 DOI: 10.3390/ijerph19148883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
We carried out a scoping review to characterize the primary quantitative evidence addressing changes in key individual/structural determinants of substance use risks and health outcomes over the first two waves of the COVID-19 pandemic in the United States (US). We systematically queried the LitCovid database for US-only studies without date restrictions (up to 6 August 2021). We extracted quantitative data from articles addressing changes in: (a) illicit substance use frequency/contexts/behaviors, (b) illicit drug market dynamics, (c) access to treatment and harm reduction services, and (d) illicit substance use-related health outcomes/harms. The majority of 37 selected articles were conducted within metropolitan locations and leveraged historical timeseries medical records data. Limited available evidence supported changes in frequency/behaviors/contexts of substance use. Few studies point to increases in fentanyl and reductions in heroin availability. Policy-driven interventions to lower drug use treatment thresholds conferred increased access within localized settings but did not seem to significantly prevent broader disruptions nationwide. Substance use-related emergency medical services’ presentations and fatal overdose data showed a worsening situation. Improved study designs/data sources, backed by enhanced routine monitoring of illicit substance use trends, are needed to characterize substance use-related risks and inform effective responses during public health emergencies.
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Affiliation(s)
- Anh Truc Vo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Thomas Patton
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
| | - Amy Peacock
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC H3C 3J7, Canada;
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
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Garg R, Kitchen SA, Men S, Campbell TJ, Bozinoff N, Tadrous M, Antoniou T, Wyman J, Werb D, Munro C, Gomes T. Impact of the COVID-19 pandemic on the prevalence of opioid agonist therapy discontinuation in Ontario, Canada: A population-based time series analysis. Drug Alcohol Depend 2022; 236:109459. [PMID: 35489179 PMCID: PMC9008980 DOI: 10.1016/j.drugalcdep.2022.109459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/19/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed the impact of COVID-19, which includes the declaration of a state of emergency and subsequent release of pandemic-specific OAT guidance (March 17, 2020 to March 23, 2020) on the prevalence of OAT discontinuation. METHODS We conducted a population-based time series analysis using interventional autoregressive integrated moving average models among Ontario residents who were stable (>60 days of continuous use) and not yet stable on OAT. Specifically, we examined whether COVID-19 impacted the weekly percentage of individuals who discontinued OAT, overall and stratified by treatment type (methadone vs. buprenorphine/naloxone). Additionally, we compared demographic characteristics and patient outcomes among people stable on OAT who discontinued treatment during (March 17, 2020 to November 30, 2020) and prior (July 3, 2019 to March 16, 2020) to the pandemic. RESULTS The weekly prevalence of OAT discontinuation across the study period ranged between 0.6% and 1.1%, among those stable on treatment compared to 7.3% and 16.6%, among those not stable on treatment. Following COVID-19, there was no significant change in the percentage of Ontarians who discontinued OAT, regardless of whether they were stabilized on treatment. Among those stable on OAT, a similar proportion of patients restarted therapy and experienced opioid-related harm following an OAT discontinuation. However, mortality following OAT discontinuation must be noted, as approximately 1.4% and 0.8% of people who discontinued methadone and buprenorphine/naloxone respectively, died within 30 days of discontinuation. CONCLUSIONS Trends in the prevalence of OAT discontinuation did not significantly change during the first eight months of the COVID-19 pandemic.
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Affiliation(s)
- Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sophie A. Kitchen
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Siyu Men
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Tonya J. Campbell
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada
| | - Mina Tadrous
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada,Women’s College Hospital, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada,Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada,Department of Family and Community Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jennifer Wyman
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada,Women’s College Hospital, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada
| | - Dan Werb
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada,Department of Family and Community Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada,Division of Infectious Diseases & Global Public Health at the University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Canada
| | - Tara Gomes
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario M5S 3M2, Canada; Institute of Health Policy, Management & Evaluation at the University of Toronto, 155 College St, Toronto, Ontario M5T 3M6, Canada.
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Chen AY, Powell D, Stein BD. Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2223708. [PMID: 35881394 PMCID: PMC9327579 DOI: 10.1001/jamanetworkopen.2022.23708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/04/2022] [Indexed: 01/12/2023] Open
Abstract
Importance The opioid crisis has been exacerbated by the COVID-19 pandemic in the US, with concerns over major disruptions to medication treatment of opioid use disorder. Objective To investigate whether the COVID-19 pandemic was associated with disruption of buprenorphine and methadone supplies in the US. Design, Setting, and Participants This repeated cross-sectional study used ARCOS (Automated Reports and Consolidated Ordering System) data, which monitor the flow of controlled substances in the US, from January 1, 2012, through June 30, 2021. Manufacturers and point of sale or distribution at the dispensing or retail level, including hospitals, retail pharmacies, clinicians, midlevel clinicians, and teaching institutions, were included in the analysis. Exposures COVID-19 pandemic. Main Outcomes and Measures Quarterly supplies of buprenorphine and methadone per capita in milligrams. Results The per capita supply of methadone dropped from 13.2 mg in the first quarter of 2020 to 10.5 mg in the second quarter of 2020, whereas the per capita supply of buprenorphine increased from 3.6 mg to 3.7 mg in the same period. The per capita supply of methadone declined 20% (-2.7 mg) in the second quarter of 2020 compared with the first quarter of 2020, and the supply had not returned to 2019 levels as of June 2021, whereas the supply of buprenorphine per person increased consistently during the same period. There were considerable state disparities in the reduction of the methadone supply during the pandemic, with many states experiencing pronounced per capita supply decreases, including reductions as great as 50% in New Hampshire and Florida. These decreases in per capita methadone supply were not compensated by proportional increases in the per capita buprenorphine supply (linear fit, 0.17 [95% CI, -0.43 to 0.76]; P = .47). Conclusions and Relevance This cross-sectional study of buprenorphine and methadone supplies during the COVID-19 pandemic found a pronounced decline in the methadone supply but no disruption to the buprenorphine supply. Future research is needed to explain the pronounced state disparities in the methadone supply.
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Affiliation(s)
- Annie Y. Chen
- RAND Corporation, Boston, Massachusetts
- Pardee RAND Graduate School, Santa Monica, California
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Durand L, Keenan E, Boland F, Harnedy N, Delargy Í, Scully M, Mayock P, Ebbitt W, Vázquez MO, Corrigan N, Killeen N, Pate M, Byrne P, Cousins G. Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103768. [PMID: 35738029 PMCID: PMC9212711 DOI: 10.1016/j.drugpo.2022.103768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/30/2022]
Abstract
BACKGROUND Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. The contingency guidelines deviated, across multiple clinical domains, from pre-pandemic clinical guidelines published in 2016. The objectives of this study are to (1) identify changes introduced to OAT clinical guidelines in Ireland during the pandemic; and (2) develop consensus on whether the new recommendations should be retained beyond the pandemic, using a national Delphi consensus methodology. METHODS Clinical guidance recommendations ('statements') were generated by comparing the newly established contingency guidelines with the national 2016 Clinical Guidelines for OAT. Over two rounds of on-line Delphi testing, a panel of experts (people currently accessing OAT, psychiatrists, general practitioners, community pharmacists, a nurse, a psychologist and support/key workers) independently rated their agreement with each statement and provided comments. Statements with a median score of 4 or 5 and a lower quartile of ≥4 were classified as having reached consensus. RESULTS Forty-eight panel members were recruited, with a high participation level at Round 2 (90%, n=43). Consensus was achieved for 12 of the 19 statements at Round 1. The 7 remaining statements were revised, with 2 new statements, resulting in 9 statements at Round 2. Four statements reached consensus at Round 2. The final list includes 16 clinical guidance statements; 9 relating to assessment, 3 to OAT drug choice and dosing, 1 to take-away doses, 2 to overdose prevention and 1 to the continuation of e-prescriptions. CONCLUSIONS A wide range of stakeholders involved in the delivery and receipt of OAT agreed on 16 clinical guidance statements for inclusion in OAT clinical guidelines as we move beyond the pandemic, rather than reverting to pre-pandemic guidelines. The agreed statements relate to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Notably, consensus was not achieved for OAT drug dosage and frequency of urine testing during the stabilisation and maintenance phase of care.
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Affiliation(s)
- Louise Durand
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland
| | - Eamon Keenan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Fiona Boland
- RCSI Data Science Centre and Department of General practice, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, D02 DH60, Ireland
| | - Norma Harnedy
- HSE Addiction Services, PO Box 486, Corporate House, Mungret Street, Limerick, V94 PV34, Ireland
| | - Íde Delargy
- Irish College of General Practitioners, Lincoln Place, Dublin 2, D02 XR68, Ireland
| | - Mike Scully
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, 3/4 Foster place, Trinity College Dublin Dublin 2, Ireland
| | - William Ebbitt
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - María Otero Vázquez
- UISCE, National Advocacy Service for People who use Drugs in Ireland, 8 Cabra road, Dublin 7, D07 T1W2, Ireland
| | - Nicola Corrigan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Nicki Killeen
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Muriel Pate
- Health Service Executive, National Quality and Patient Safety Directorate, Dr. Steeven's Hospital, Dublin 8, D08 W2A8, Ireland
| | - Paula Byrne
- Merchants Quay Ireland Head Office, Merchants Court, 24 Merchants Quay, Dublin 8, D08 × 7YK, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland.
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Meadowcroft D, Davis W. Understanding the Effect of the COVID-19 Pandemic on Substance Use Disorder Treatment Facility Operations and Patient Success: Evidence From Mississippi. Subst Abuse 2022; 16:11782218221095872. [PMID: 35592585 PMCID: PMC9112314 DOI: 10.1177/11782218221095872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to disruptions in the provision of care at substance use disorder (SUD) treatment facilities. Stresses associated with the pandemic could also negatively impact treatment outcomes for clients. The aim of this study is to evaluate how SUD treatment facilities in Mississippi changed their operations following the start of the pandemic. The change in client success rates at the facilities is also assessed. METHODS An online survey was completed by 12 SUD treatment facilities in Mississippi between February and May 2021. RESULTS Generally, the facilities' capacity to provide treatment to clientele was moderately affected by the pandemic. Facilities in the sample also adapted a variety of policies to limit the spread of COVID-19. Changes in the services provided by facilities was observed in the survey responses. For client success rates reported by the facilities, there was a decrease in the number of facilities stating that more than 80% of their clients completed treatment across the pre- and post-pandemic periods. However, the number of facilities with more than 80% of their clients successfully finishing treatment has increased in recent months. CONCLUSIONS To continue serving their clientele during the pandemic, facilities enacted COVID-19-related policies and began offering new services such as telehealth. Although client success rates decreased at the beginning of the pandemic, they have returned to pre-pandemic levels in recent months. Our results indicate that SUD treatment facilities and clients have improved in terms of giving and receiving care as the pandemic has progressed.
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Affiliation(s)
- Devon Meadowcroft
- Delta Research and Extension Center,
Mississippi State University, Stoneville, Mississippi, MS, USA
| | - Will Davis
- Department of Agricultural Economics,
Mississippi State University, Starkville, Mississippi, MS, USA
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Fugelstad A. What lessons from Sweden's experience could be applied in the United States in response to the addiction and overdose crisis? Addiction 2022; 117:1189-1191. [PMID: 35373488 PMCID: PMC9325407 DOI: 10.1111/add.15847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Anna Fugelstad
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
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43
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Harris MTH, Lambert AM, Maschke AD, Bagley SM, Walley AY, Gunn CM. "No home to take methadone to": Experiences with addiction services during the COVID-19 pandemic among survivors of opioid overdose in Boston. J Subst Abuse Treat 2022; 135:108655. [PMID: 34772604 PMCID: PMC8576611 DOI: 10.1016/j.jsat.2021.108655] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/13/2021] [Accepted: 11/02/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a qualitative study to explore the impact of the COVID-19 pandemic on experiences with addiction treatment and harm reduction services. METHODS The study recruited participants from Boston, Massachusetts, aged 18-65 who had a history of opioid use disorder and overdose, from a parent study (REpeated dose Behavioral intervention to reduce Opioid Overdose, REBOOT) to participate between August and October 2020. In-depth individual interviews explored the impact of the COVID-19 pandemic on addiction service experiences. We conducted a grounded content analysis that examined codes related to addiction service access and engagement during the pandemic to compare and categorize participants according to their experiences. RESULTS The study enrolled twenty participants. The mean age was 42 years; most identified as white (n = 16); ten participants identified as men, nine as cis-gender women, and one as a trans-gender woman. Participants described their experiences with COVID-19-driven changes to addiction care (methadone take homes, televisits for either buprenorphine or behavioral health services, and syringe service outreach) access and engagement as: 1) liberating (n = 7), 2) destabilizing (n = 8), or 3) unjust (n = 5). Participants in the liberating group found adaptations allowed for increased flexibility, freedom, and safety from COVID-19. This group was mostly housed and had strong social supports that facilitated participation in adapted treatment programs. COVID-19-related changes to addiction treatment disrupted routine and community supports among those in the destabilizing group. Participants in the unjust group felt that adaptations exacerbated inequities as a lack of housing and other social supports prohibited them from benefiting from the relaxed restrictions to methadone or buprenorphine. This group was mostly unhoused and found that adaptations did not adequately mitigate other inequities worsened by public health mandates for unhoused people who use drugs. CONCLUSION Relaxed restrictions on medications for opioid use disorder created opportunities for improved patient-centered care. Concrete measures that address service barriers, such as phone or transportation access, may have reduced destabilizing and unjust experiences reported by our participants. However, addiction care inequities will persist if drivers of marginalization, specifically a lack of housing, remain unaddressed.
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Affiliation(s)
- Miriam T H Harris
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Audrey M Lambert
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Ariel D Maschke
- Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Sarah M Bagley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
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Simon C, Vincent L, Coulter A, Salazar Z, Voyles N, Roberts L, Frank D, Brothers S. The Methadone Manifesto: Treatment Experiences and Policy Recommendations From Methadone Patient Activists. Am J Public Health 2022; 112:S117-S122. [PMID: 35349312 PMCID: PMC8965191 DOI: 10.2105/ajph.2021.306665] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Caty Simon
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Louise Vincent
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Abby Coulter
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Zach Salazar
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Nick Voyles
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Lindsay Roberts
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - David Frank
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
| | - Sarah Brothers
- All of the authors are with the Urban Survivors Union Methadone Advocacy and Reform Working Group. Caty Simon and Lindsay Roberts are with Whose Corner Is It Anyway, Holyoke, MA. Louise Vincent and Zach Salazar are with North Carolina Survivors Union, Greensboro. Abby Coulter is with Medication Assisted Treatment Support & Awareness, Morgantown, WV. Nick Voyles is with the Indiana Recovery Alliance, Bloomington. David Frank is with the School of Global Public Health, New York University, New York, NY. Sarah Brothers is with the Department of Sociology and School of Public Policy, Pennsylvania State University, University Park
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Wyatt JP, Suen LW, Coe WH, Adams ZM, Gandhi M, Batchelor HM, Castellanos S, Joshi N, Satterwhite S, Pérez-Rodríguez R, Rodríguez-Guerra E, Albizu-Garcia CE, Knight KR, Jordan A. Federal and State Regulatory Changes to Methadone Take-Home Doses: Impact of Sociostructural Factors. Am J Public Health 2022; 112:S143-S146. [PMID: 35349318 PMCID: PMC8965186 DOI: 10.2105/ajph.2022.306806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Janan P Wyatt
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Leslie W Suen
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - William H Coe
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Zoe M Adams
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Mona Gandhi
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Hannah M Batchelor
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Stacy Castellanos
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Neena Joshi
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Shannon Satterwhite
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Rafael Pérez-Rodríguez
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Esther Rodríguez-Guerra
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Carmen E Albizu-Garcia
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Kelly R Knight
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Ayana Jordan
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
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Bandara S, Maniates H, Hulsey E, Smith JS, DiDomenico E, Stuart EA, Saloner B, Krawczyk N. Opioid treatment program safety measures during the COVID-19 pandemic: a statewide survey. BMC Health Serv Res 2022; 22:418. [PMID: 35354460 PMCID: PMC8965537 DOI: 10.1186/s12913-022-07832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background Opioid treatment programs (OTPs) serve as daily essential services for people with opioid use disorder. This study seeks to identify modifications to operations and adoption of safety measures at Pennsylvania OTPs during the COVID-19 pandemic. Methods A 25-min online survey to clinical and administrative directors at all 103 state-licensed OTPs in Pennsylvania was fielded from September to November 2020. Survey domains included: 1) changes to services, client volume, hours and staffing during the COVID-19 pandemic 2) types of services modifications 3) safety protocols to reduce COVID-19 transmission 4) challenges to operations during the pandemic. Results Forty-seven directors responded, for a response rate of 45%. Almost all respondents reported making some service modification (96%, n = 43). Almost half (47%, n = 21) of respondents reported reductions in the number of clients served. OTPs were more likely to adopt safety protocols that did not require significant funding, such as limiting the number of people entering the site (100%, n = 44), posting COVID-safety information (100%, n = 44), enforcing social distancing (98%, n = 43), and increasing sanitation (100%, n = 44). Only 34% (n = 14) of OTPS provided N95 masks to most or all staff. Respondents reported that staff’s stress and negative mental health (86%, n = 38) and staff caregiving responsibilities (84%, n = 37) during the pandemic were challenges to maintaining OTP operations. Conclusion OTPs faced numerous challenges to operations and adoption of safety measures during the COVID-19 pandemic. Funding mechanisms and interventions to improve adoption of safety protocols, staff mental health as well as research on patient experiences and preferences can inform further OTP adaptation to the COVID-19 pandemic and future emergency planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07832-7.
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Affiliation(s)
- Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Hannah Maniates
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Eric Hulsey
- Vital Strategies, 100 Broadway 4th Floor, New York, NY, 10005, USA
| | - Jennifer S Smith
- Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA, 17110, USA
| | - Ellen DiDomenico
- Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA, 17110, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
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Tilhou AS, Dague L, Saloner B, Beemon D, Burns M. Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic. JAMA HEALTH FORUM 2022; 3:e220093. [PMID: 35977284 PMCID: PMC8917419 DOI: 10.1001/jamahealthforum.2022.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/18/2022] [Indexed: 01/04/2023] Open
Abstract
Question During the COVID-19 public health emergency, did patients with opioid use disorder experience decreased access to opioid use disorder treatment? Findings In this cohort study of 6453 Medicaid beneficiaries with opioid use disorder in Wisconsin, buprenorphine possession remained stable at the onset and for the first 6 months of the public health emergency. In contrast, completion of urine drug tests and receipt of opioid treatment program services declined with the onset of the public health emergency and recovered partially 6 months into the public health emergency. Meaning The findings of this study suggest that the COVID-19 public health emergency did not disrupt access to buprenorphine but did disrupt urine drug testing and access to opioid treatment program services. Importance Disruptions in care during the COVID-19 pandemic may have decreased access to care for patients with opioid use disorder. Objective To examine trends in opioid use disorder treatment including buprenorphine possession, urine drug testing, and opioid treatment program services during the COVID-19 public health emergency. Design, Setting, and Participants This cohort study included 6453 parent and childless adult Medicaid beneficiaries, aged 18 to 64 years, with opioid use disorder and continuous enrollment from December 1, 2018, to September 30, 2020, in Wisconsin. Logistic regression compared differences in study outcomes before, early, and later in the COVID-19 public health emergency. Analyses were conducted from January 2021 to October 2021. Exposures Early (March 16, 2020, to May 15, 2020) and later (May 16, 2020, to September 30, 2020) in the public health emergency. Main Outcomes and Measures Person-week outcomes included possession of buprenorphine, completion of outpatient urine drug testing, and receipt of opioid treatment program services. Results The final cohort of 6453 participants included 3986 (61.8%) childless adults; 5741 (89%) were younger than 50 years, 3435 (53.2%) were women, 5036 (78.0%) White, and 22.0% were racial and ethnic minority groups (American Indian, 269 [4.2%]; Asian, 26 [0.4%]; Black, 458 [7.1%]; Hispanic, 292 [4.5%]; Pacific Islander, 1 [.02%]; Multiracial, 238 [3.7%]). Overall, 2858 (44.3%), 5074 (78.6%), and 2928 (45.4%) received buprenorphine, urine drug testing, or opioid treatment program services during the study period, respectively. Probability of buprenorphine possession did not change in the early or later part of the public health emergency. Probability of urine drug testing initially decreased (marginal effect [ME], –0.04; 95% CI, –0.04 to –0.03; P < .001) and then partially recovered in the later public health emergency (ME, –0.02; 95% CI, –0.03 to –0.02; P < .001). Probability of opioid treatment program services followed a similar pattern, with an early decrease (ME, –0.05; 95% CI, –0.05 to –0.04; P < .001) followed by partial recovery (ME, –0.02; 95% CI, –0.03 to –0.02; P < .001). Conclusions and Relevance In a sample of continuously enrolled adult Medicaid beneficiaries, the COVID-19 public health emergency was not associated with decreased probability of buprenorphine possession, but was associated with decreased probability of urine drug testing and opioid treatment program services. These findings suggest patients in office-based settings retained access to buprenorphine despite decreased on-site services like urine drug tests, whereas patients at opioid treatment programs experienced greater disruption in care. Given the importance of medications for opioid use disorder in preventing overdose, policy makers should consider permanent policy changes based on lessons learned from the public health emergency to enable ongoing enhanced access to these medications.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Laura Dague
- Department of Public Service and Administration, Texas A&M University, College Station, Texas
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Beemon
- Department of Economics, University of Wisconsin-Madison, Madison
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison
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Trayner KM, McAuley A, Palmateer NE, Yeung A, Goldberg DJ, Glancy M, Hunter C, Ritchie T, Craik J, Raeburn F, McTaggart S, Barnsdale L, Campbell J, Shepherd SJ, Bradley-Stewart A, Gunson RN, Templeton K, Hutchinson SJ. Examining the impact of the first wave of COVID-19 and associated control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: an interrupted time series study. Drug Alcohol Depend 2022; 232:109263. [PMID: 35120807 PMCID: PMC8802039 DOI: 10.1016/j.drugalcdep.2021.109263] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND COVID-19 has likely affected the delivery of interventions to prevent blood-borne viruses (BBVs) among people who inject drugs (PWID). We examined the impact of the first wave of COVID-19 in Scotland on: 1) needle and syringe provision (NSP), 2) opioid agonist therapy (OAT) and 3) BBV testing. METHODS An interrupted time series study design; 23rd March 2020 (date of the first 'lockdown') was chosen as the key date. RESULTS The number of HIV tests and HCV tests in drug services/prisons, and the number of needles/syringes (N/S) distributed decreased by 94% (RR=0.062, 95% CI 0.041-0.094, p < 0.001), 95% (RR=0.049, 95% CI 0.034-0.069, p < 0.001) and 18% (RR = 0.816, 95% CI 0.750-0.887, p < 0.001), respectively, immediately after lockdown. Post-lockdown, an increasing trend was observed relating to the number of N/S distributed (0.6%; RR = 1.006, 95% CI 1.001-1.012, p = 0.015), HIV tests (12.1%; RR = 1.121, 95% CI 1.092-1.152, p < 0.001) and HCV tests (13.2%; RR = 1.132, 95 CI 1.106-1.158, p < 0.001). Trends relating to the total amount of methadone prescribed remained stable, but a decreasing trend in the number of prescriptions (2.4%; RR = 0.976, 95% CI 0.959-0.993, p = 0.006) and an increasing trend in the quantity prescribed per prescription (2.8%; RR = 1.028, 95% CI 1.013-1.042, p < 0.001) was observed post-lockdown. CONCLUSIONS COVID-19 impacted the delivery of BBV prevention services for PWID in Scotland. While there is evidence of service recovery; further effort is likely required to return some intervention coverage to pre-pandemic levels in the context of subsequent waves of COVID-19.
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Affiliation(s)
- Kirsten M.A. Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK,Corresponding author at: School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Norah E. Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - David J. Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Carole Hunter
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Trina Ritchie
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Julie Craik
- Public Health Protection Unit, Gartnaval Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, G12 0XH, UK
| | - Fiona Raeburn
- NHS Grampian Drug and Alcohol Services, Fulton Clinic, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, UK
| | - Stuart McTaggart
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Lee Barnsdale
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - John Campbell
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Samantha J. Shepherd
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | | | - Rory N. Gunson
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - Sharon J. Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
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Kitchen SA, Campbell TJ, Men S, Bozinoff N, Tadrous M, Antoniou T, Wyman J, Werb D, Munro C, Gomes T. Impact of the COVID-19 pandemic on the provision of take-home doses of opioid agonist therapy in Ontario, Canada: a population-based time-series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103644. [PMID: 35272107 PMCID: PMC8885322 DOI: 10.1016/j.drugpo.2022.103644] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
Background In March 2020, the Ontario government declared a state of emergency due to the growing risk of COVID-19. In response, new guidance for the management of opioid agonist therapy (OAT) was released, which included the expansion of eligibility for take-home doses. We investigated the impact of these changes on trends in the distribution of take-home doses of OAT. Methods We conducted a population-based time series analysis among residents of Ontario, Canada who were dispensed OAT between June 25, 2019 and November 30, 2020. For each week of the study period, we calculated the percentage of people dispensed (a) methadone and (b) buprenorphine/naloxone by the number of take-home doses received. We used interventional autoregressive integrated moving average models to estimate changes in the percentage of people dispensed each category of take-home doses in the weeks following the declaration of the state of emergency and release of the OAT dispensing guidance. Results Following the state of emergency and release of the OAT dispensing guidance, there was a significant increase in the percentage of Ontarians dispensed 7 to 13 (3.6% increase; p = 0.033) and 14 or more (0.8% increase; p<0.001) take-home doses of methadone, and in the percentage of people dispensed 7 to 13 (4.3% increase; p = 0.001), 14 to 27 (2.8% increase; p<0.001), and 28 or more (0.3% increase; p = 0.008) take-home doses of buprenorphine/naloxone. There were significant decreases in the percentage of Ontarians receiving daily dispensed buprenorphine/naloxone (-3.1%; p = 0.001), as well as the percentage dispensed 1 to 6 take-home doses of methadone (-4.5%; p = 0.001) and buprenorphine/naloxone (-4.9%; p = 0.001). Conclusion The new guidance for dispensing OAT in Ontario resulted in increases in the duration of take-home doses of methadone and buprenorphine/naloxone supplied. However, given that changes were small, strategies to improve retention in OAT and ensure equitable access to take-home dosing should continue.
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Maqoud F, Fabio G, Ciliero N, Antonacci M, Mastrangelo F, Sammarruco G, Cataldini R, Schirosi G, De Fazio S, Tricarico D. Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy. Pharmaceutics 2022; 14:pharmaceutics14020461. [PMID: 35214192 PMCID: PMC8878258 DOI: 10.3390/pharmaceutics14020461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
A multicenter-observational study was performed to assess the effectiveness of rac-methadone, levomethadone, and buprenorphine in opioid-dependent patients in polytherapy in Southern Italy. The primary endpoint was the reduction of urinary positivity to the substances and the maintaining doses. Patients (N = 266, age = 44.80 ± 5.65, male = 79.70%, female = 20.30%) have been recruited. At recruitment, 75% of them were on treatment with rac-methadone, levomethadone, and buprenorphine/naloxone. The patients were grouped into three clusters. The levomethadone patients of Cluster A (N patients = 211), after 180 days, showed stability in urinary methadone positivity, with a marked decrease in heroin −53 ± 4%, cannabinol’s −48 ± 2%, and cocaine −37 ± 6% positivity, with no differences between treatments. A lower QTcF value of 426 ± 8.4 ms was recorded in the levomethadone patients (delta = −19 ms) vs. rac-methadone, at significantly lower doses of levomethadone (−34%, −50.2% in males) (p < 0.05). The Cluster B data were collected from 37 patients, with a high prevalence of comorbidity infections (HIV/HCV/HPV), monitored for 21 months during COVID-19. High doses of levomethadone (58.33 ± 31.58 mg/day) were needed to stabilize those that were negative for opioids and cannabinoids, in contrast to the rac-methadone and buprenorphine/naloxone patients that showed positive toxicology. Eighteen patients of the Cluster C in double diagnosis (major depressive 38.90%, bipolar 27.78%, and schizophrenia 16.67%) were stabilized with high doses of racemate 97.5 ± 8 mg/day, 51.8 ± 5 mg/day of levomethadone (−46.8% vs. rac-methadone; −71% in men), and 2.5 ± 1 mg/day of buprenorphine/naloxone. Three patients in remission were treated with tapering doses of levomethadone. Significantly reduced QTcF values were recorded with levomethadone (delta −32 ms vs. rac-methadone) in the bipolar patients, as well as the schizophrenia patients in remission (delta −45.19 ms vs. rac-methadone). Our patients were safely stabilized. Levomethadone, compared to the racemate, contributes to reducing the illicit use, especially of opioids and cannabinoids at significantly lower doses with cardiovascular safety, which, in bipolar patients, is clinically significant.
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Affiliation(s)
- Fatima Maqoud
- Department of Pharmacy-Pharmaceutical Sciences, Pharmacology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (F.M.); (N.C.); (M.A.)
| | - Giada Fabio
- Ser.D. Bari, ASL-BA, Via Amendola, 124/C, 70126 Bari, Italy;
| | - Nunzio Ciliero
- Department of Pharmacy-Pharmaceutical Sciences, Pharmacology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (F.M.); (N.C.); (M.A.)
| | - Marina Antonacci
- Department of Pharmacy-Pharmaceutical Sciences, Pharmacology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (F.M.); (N.C.); (M.A.)
| | - Francesca Mastrangelo
- Ser.D. Lanciano, ASL2 Lanciano-Vasto-Chieti, Via Martiri Lancianesi 17/19, 66100 Chieti, Italy;
| | - Giorgio Sammarruco
- Ser.D. Poggiardo, Piazza Partigiani, s.n.c., Poggiardo, 73037 Lecce, Italy;
| | - Roberto Cataldini
- U.O. Double Diagnosis Gallipoli, Via Marconi, 1, 73014 Gallipoli, Italy;
| | - Gabriella Schirosi
- Ser.D. Taranto, Contrada “Rondinella” c/o Ospedale “Testa” Strada Statale 106, 74100 Taranto, Italy;
| | | | - Domenico Tricarico
- Department of Pharmacy-Pharmaceutical Sciences, Pharmacology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (F.M.); (N.C.); (M.A.)
- Correspondence:
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