Key PointsQuestionAmong recipients of opioid agonist therapy (OAT) in Ontario, Canada, early in the COVID-19 pandemic, was there an association between dispensing of increased take-home doses and treatment retention or opioid-related harm?FindingsIn this retrospective propensity-weighted cohort study of 21 297 OAT recipients stratified by baseline dosing and type of OAT, dispensing of increased take-home doses of OAT, compared with no change in take-home doses, was significantly associated with lower rates of OAT interruption and discontinuation in most subsets, with no statistically significant increases in opioid overdoses over 6 months of follow-up.MeaningIn Ontario, Canada, during the COVID-19 pandemic, dispensing of increased take-home doses of OAT was significantly associated with lower rates of treatment interruption and discontinuation among some subsets of patients, and there were no statistically significant increases in opioid-related overdoses, although the findings may be susceptible to residual confounding and should be interpreted cautiously.
Background
The COVID-19 pandemic has exacerbated the opioid crisis. Opioid-related deaths have increased and access to treatment services, including opioid agonist treatment (OAT), has been disrupted. The Ontario COVID-19 OAT Treatment Guidance document was developed to facilitate access to OAT and continuity of care during the pandemic, while supporting physical distancing measures. In particular, the Guidance expanded access to unsupervised OAT dosing. It is important to evaluate the changes in unsupervised OAT dosing after the release of the Ontario COVID-19 OAT Guidance based on patients’ and prescribers’ reports.
Method
Online questionnaires were developed collaboratively with people with lived and living expertise, prescribers, clinical experts, and researchers. Patients (
N
=402) and prescribers (
N
=100) reported their experiences with changes in unsupervised dosing during the first six months of the pandemic.
Results
Many patients (57%) reported receiving additional unsupervised OAT doses (i.e., take away doses). Patients who received additional unsupervised doses were not significantly more likely to report adverse health outcomes compared to patients who did not receive additional unsupervised doses. Patients with additional unsupervised doses and prescribers agreed that changes in OAT care were positive (e.g., reported an improved patient-prescriber relationship and more openness between patient and prescriber). Prescribers and some patients reported the need for continued flexibility in unsupervised doses after the pandemic restrictions lift.
Conclusions
Results support the need to re-evaluate historical approaches to OAT care delivery, particularly unsupervised doses. It is crucial to implement policies, regulations, and supports to reduce barriers to OAT care during the pandemic and once the pandemic response restrictions are eased. Flexibility in OAT care delivery, particularly unsupervised dosing, will be key to providing patient-centred care for persons with opioid use disorder.
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