Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care?

Abstract

In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.

Overview of SARS-CoV-2 infection in adults living with HIV

“… 100 Some centres have ensured a sufficient quantity of take-home doses for patients on methadone maintenance treatment to maximise their adherence during COVID-19-related lockdowns. 101 …”

“…100 Some centres have ensured a sufficient quantity of take-home doses for patients on methadone maintenance treatment to maximise their adherence during COVID-19-related lockdowns. 101 The COVID-19 pandemic has affected mental health, particularly in patients with pre-existing psychiatric disorders. 102 The consequences were substantially higher among people living with HIV, in racial and ethnic minorities, immigrants, transgender people, sex workers, and socioeconomically disadvantaged groups.…”

The impact of COVID‐19 on alcohol and other drug nurses' provision of care: A qualitative descriptive study

“…Finally, the physical distancing and isolation requirements did see an increase in the use of long‐acting injectable buprenorphine formulations and take‐home methadone doses. Early evaluation research of similar flexibility in dosing conducted in Spain notes that this practice is largely a success and should continue beyond the pandemic (Trujols et al, 2020); however, local research needs to be conducted to evaluate the ongoing efficacy of this approach. What is clear, however, is that the role of the nurse is essential in administering and monitoring the effects of both flexible dosing regimens and long‐acting injectable preparations (Go et al, 2011).…”

“…A reduction in face-to-face contact was described as a threat to maintaining rapport with consumers of AOD treatment ser- Finally, the physical distancing and isolation requirements did see an increase in the use of long-acting injectable buprenorphine formulations and take-home methadone doses. Early evaluation research of similar flexibility in dosing conducted in Spain notes that this practice is largely a success and should continue beyond the pandemic (Trujols et al, 2020); however, local research needs to be conducted to evaluate the ongoing efficacy of this approach.…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…The largest group of studies focused on treatment/recovery services (Table 5). Six of the eight studies sought the views of PWUD regarding the impact of the COVID-19 pandemic [36,37,42,53,54,61]. There is good quality evidence that the pandemic has had serious impacts on thoughts, feelings and behaviours such as stress, anger and feelings of isolation.…”