Adapting a Low-threshold Buprenorphine Program for Vulnerable Populations During the COVID-19 Pandemic

Abstract

Objectives: To examine patient characteristics and outcomes among opioid use disorder patients enrolled in low-threshold buprenorphine treatment during the COVID-19 pandemic. Methods: This paper describes the adaptation of the Project Connections (PC) program, a low-threshold buprenorphine program in Baltimore, in response to the COVID-19 pandemic. This paper examines patient characteristics and initial outcomes of patients served during a rapid protocol shift to telehealth that allowed buprenorphine initiation without an in-person encounter following a state-mandated stay-at-home order. Patient characteristics were compared to a subsample of patients enrolled in the program before the COVID-19 pandemic. Results: In March 2020, there was a sharp increase in new enrollments to the PC program. A total of 143 patients completed an intake assessment between March and May 2020 and 140 began treatment with buprenorphine/naloxone. Those who completed an intake assessment were primarily male (68.5%), Black (83.2%), had a mean age of 43.2 years (SD = 11.7), and reported a mean of 17.0 years of opioid use (SD = 12.9). The majority of patients were unemployed (72.7%) and reported previous criminal justice involvement (69.2%). Of those who completed an intake assessment, 96.5% returned for a second visit. Among those for whom 30-day retention data was available (n = 113), 63.7% were engaged for 30 days or longer. Conclusions: The PC program illustrates that offering on-demand, flexible treatment is an opportunity to increase opioid use disorder treatment access, even during a public health emergency that disrupted access to services. Relaxation of buprenorphine telehealth regulations allowed for flexibility in treatment and benefits vulnerable populations.

A comparison of office-based buprenorphine treatment outcomes in Bronx community clinics before versus during the COVID-19 pandemic

“…In that study, 54% of patients were retained in treatment at 8 weeks (and 27% were transitioned to a community treatment program). In the other study, Nordeck and colleagues reported a sharp increase in patients who completed an initial visit and initiated treatment during the pandemic in Baltimore ( Nordeck et al, 2020 ). They found no differences in patient characteristics or treatment outcomes among patients who initiated treatment before versus during the pandemic.…”

“…Although published narratives describe changes in OUD treatment delivery during the pandemic ( Buchheit, Wheelock, Lee, Brandt, & Gregg, 2021 ; Clark et al, 2021 ; Samuels et al, 2020 ; Wang et al, 2021 ), to our knowledge, only two manuscripts have reported patient outcomes ( Nordeck et al, 2020 ; Tofighi et al, 2021 ), and none have compared the full cascade of OUD treatment outcomes before versus during the pandemic. Of the two studies that examined patient outcomes, neither included patients who were referred to buprenorphine treatment but did not initiate care.…”

“…These policy changes have the potential to improve access to and retention in OUD treatment ( Kleinman & Morris, 2021 ). However, few studies have examined patient outcomes in buprenorphine treatment during the pandemic ( Nordeck, Buresh, Krawczyk, Fingerhood, & Agus, 2020 ; Tofighi et al, 2021 ). In the context of the worst drug overdose epidemic ever in the US, it is critical to understand how rapid changes in health care policies and health care delivery during the COVID-19 pandemic impacted buprenorphine treatment outcomes.…”

Big Events theory and measures may help explain emerging long-term effects of current crises

“…As we suggested earlier in this article, the impacts of Big Events on health are indeterminate, but can be studied and intervened upon (except in situations of extreme conflict; Figure 2). In the current Big Events that involve the combination of the COVID-19 pandemic and economic hard times, community mutual aid efforts have helped relieve economic and mental distress to a limited extent in some communities, access to medications for opioid disorder was made easier in many jurisdictions, and contact tracing interventions, where they could be carried out, sometimes reduced viral transmission (Koetter et al, 2020;Malm, 2020;Nordeck et al, 2020). In addition, some states in the United States froze utility shutoffs due to COVID-19 economic difficulties.…”

Maintaining treatment and prevention programs for opioid use disorders during the coronavirus disease 2019 pandemic

“…SAMHSA also made the decision that in-person examination for buprenorphine prescription is not mandatory during the pandemic and patients could be prescribed the buprenorphine via telehealth, though this did not apply for methadone treatment [ 26 ]. A study of the low-threshold buprenorphine program in Baltimore showed that 96.5% of the patients returned for a second visit after their initial assessment by telehealth and 63.7% were engaged for 30 days or longer, which indicated the feasibility and the benefit of this loosening policy [ 27 ▪▪ ].…”