Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

Abstract

Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

“…Telemedicine services were often instituted to initiate or continue treatment with buprenorphine while minimizing in-person patient-physician encounters. Telemedicine-based buprenorphine was implemented across a range of settings, from nation-wide (Crowley et al [ 29 ] and local hotlines (Samuels et al [ 30 ]) to existing substance use treatment programs (Singh and Tikka [ 31 ]; Vecchio et al [ 32 ]; Quiñones et al [ 33 ]), street outreach clinics (Castillo et al [ 34 ]; Tringale et al [ 35 ]; Nordeck et al [ 36 ]; Harris et al [ 37 ]) and correctional facilities (Duncan et al [ 38 ]). Many buprenorphine telemedicine programs also reported prescribing medications for longer durations than usual to reduce the volume of follow up appointments.…”

“…Marcus et al [ 54 ] described already strained shelter resources that made it extremely difficult to manage hygiene and social distancing among people receiving methadone in a makeshift health service in South Africa. Financial challenges related to the inability of patients to pay for their own medications, such as in the case of patients receiving buprenorphine prescriptions from a syringe exchange program [ 34 ]. Others described barriers related to delivering medications to patients, whether due to supply chain issues such as limited interstate transport of medication [ 45 ], a lack of pharmacies that stock buprenorphine, as [ 34 ], or simply due to the restricted ability of patients and providers to travel long distances during the pandemic [ 48 ].…”

“…Financial challenges related to the inability of patients to pay for their own medications, such as in the case of patients receiving buprenorphine prescriptions from a syringe exchange program [ 34 ]. Others described barriers related to delivering medications to patients, whether due to supply chain issues such as limited interstate transport of medication [ 45 ], a lack of pharmacies that stock buprenorphine, as [ 34 ], or simply due to the restricted ability of patients and providers to travel long distances during the pandemic [ 48 ]. Lastly, other common obstacles included confusion and lack of clear communication by authorities around how to shift MOUD practices (e.g.…”

“…Despite these obstacles, several programs described innovations ensuring continuity of care. First and foremost, most programs acknowledged the critical role of relaxed regulations around MOUD and harm reduction as well as generally greater leniency around OUD service provision that allowed them to provide lower threshold services under COVID-19 conditions [ 30 , 34 , 35 , 37 , 38 , 43 , 44 , 46 , 48 ]. Others acknowledged particular elements of their health system as supporting efforts to provide rapid MOUD services, such as a linked healthcare system in Ireland as described by Crowley et al [ 29 ].…”

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“…COVID-19−related temporary policy changes to federal guidance for MOUD treatment providers that allow telehealth to substitute in-person visits and increased number of doses patients bring home are positive improvements and should become permanent. 114 Telehealth capacity in SSPs could greatly improve access to health services; an SSP in Miami recently implemented a free telehealth system to help clients initiate MOUD, 115 which could provide a framework for expanding access to other clinical services, including PrEP and ART.…”