Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

Abstract

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.

Evaluating interventions to facilitate opioid agonist treatment access among people who inject drugs in Toronto, Ontario during COVID-19 pandemic restrictions

“…The relatively static level of OAT enrollment post-implementation is likely owed to the immediate and sustained increase in the proportion of OAT-enrolled participants receiving take-home doses and the immediate, albeit temporary, decrease in the proportion undergoing weekly urine drug screening. Specifically, the increased likelihood of receiving take-home doses following the OAT modifications and corresponding decreased likelihood of routine urine drug screening (at least initially) may have facilitated treatment retention despite pandemic restrictions by reducing OAT patients’ in-person clinical encounters and affording greater flexibility in their dosing schedules ( Corace et al, 2022 ; Haasen & Brink, 2006 ; Sarasvita et al, 2012 ; Schaub et al, 2010 ). These post-implementation changes are likely attributable to the provincial interim treatment guidance, which explicitly recommended that prescribers and pharmacists reduce the frequency of urine drug screening and observed doses for OAT patients during the COVID-19 pandemic ( Centre for Addiction and Mental Health et al, 2020 ).…”

Opioid agonist treatment take-home doses (‘carries’): Are current guidelines resulting in low treatment coverage among high-risk populations in Canada and the USA?

“…Early Canadian data further indicate that most people who received additional carries were no more likely to experience adverse outcomes (e.g., self-reported opioid overdoses, emergency department visits, etc.) than those who did not receive carries [ 74 , 75 ]. However, most clinicians reported that they prescribed carries to patients only when they felt sure of the patient’s social and housing stability, which means that the perpetuation of inequitable access to OAT carries still exists for some high-risk populations, even during a period of loosened OAT carry prescription policies.…”

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study

“…In response to these challenges, Ireland, like many other countries, developed a rapid and coordinated response to accelerate new ways of meeting the treatment needs of people with opioid dependency, documented in a suite of national contingency guidelines by the Health Service Executive (HSE) ( Hennigan, Corrigan, Killeen, Scully, & Keenan, 2021 ; Krawczyk, Fawole, et al, 2021 ; Mongan, Galvin, Farragher, Dunne, & Nelson, 2020 ). The priority was to facilitate rapid access or low threshold pathways to OAT for those not already in treatment, while ensuring that existing patients’ care was uninterrupted ( Corace et al, 2022 ; Hennigan et al, 2021 ; Khatri & Perrone, 2020 ; Krawczyk, Fawole, et al, 2021 ; O'Carroll, Duffin, & Collins, 2021 ). The contingency guidelines supported accelerated access to OAT, particularly for the homeless, and included increased access to buprenorphine.…”