Medications for opioid use disorder during war in Ukraine: Innovations in public and private clinic cooperation

Bromberg, Daniel J.; Madden, Lynn M.; Meteliuk, Anna; Ivasiy, Roman; Leon, Samy J. Galvez de; Klyucharyov, Konstantin; Altice, Frederick L.

doi:10.1016/j.lanepe.2022.100490

Cited by 14 publications

(15 citation statements)

References 6 publications

(6 reference statements)

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“…Economic uncertainty that was a fundamental characteristic of OAT providers’ experiences pre-crisis, intensified since the Russian invasion. OAT providers were uncertain if the medication supply would be replenished or depleted ( 33 , 34 ), but our findings indicate that they had to ration their inventory of medication already before the crisis during the “Old Normal”. Likewise, the war made staff shortages more acute, but they predated the crisis, especially among the junior frontline staff like nurses, who, unlike more senior specialists, could not perform their work via telehealth but needed to be physically present on premises and thus at high risk if the facility was hit and destroyed.…”

Section: Discussionmentioning

confidence: 83%

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

Dellamura,

Meteliuk,

Fomenko

et al. 2024

Front. Public Health

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PurposeThis paper seeks to explore and understand what constitutes successful opioid agonist therapy (OAT) programs from the views of Ukrainian OAT providers in their context-specific accounts. Prior to the ongoing war the Ukrainian addiction treatment system made great strides to expand its OAT program and increase the number of patients. Since the beginning of the war there has been much alarm that those hard-earned successes will be destroyed. However, emerging evidence suggests that the Ukrainian OAT programs have shown signs of resilience in the face of adversity albeit at great cost. What aspects of the OAT programs developed prior to the crisis have been helpful to allow them to weather the storm? Using the data from 24 addiction treatment providers, this paper describes the essential elements of the OAT programs that preceded the current crisis which made them robust over time. By examining the narratives of the participants interviewed pre-war and pre-COVID-19 the paper reveals structural and cultural elements of the OAT programs before the perfect storm that are likely to endure. To the best of our knowledge, no one else has investigated OAT providers perspectives in Ukraine prior to the crisis which makes this paper extremely salient to understand both the robustness and the vulnerability of MAT programs in Ukraine during the war and going forward.MethodologyThe data come from qualitative semi-structured interviews with 24 OAT providers throughout 5 regions of Ukraine. Participants included front-line clinicians, head narcologists, and chief doctors from TB clinics, district hospitals and drug addiction centers. Using a coding scheme of 103 inductively developed categories we explored participants’ perceptions of their OAT program.FindingsIn the stories shared by clinicians pre crisis, three major interconnected themes focused on economic uncertainty at the institutional level (leading to under-staffing), structural capacity of the program, and clinicians’ professional identity, shaping differing views on application of rules for administrative discharge, take-home dosing, and the potential for scale-up. Knowing the data collection was completely unbiased to the current crisis, interpreting the findings helps us understand that OAT clinicians have had “years” of training under conditions of duress in Ukraine to overcome barriers, find creative solutions and form a support network that became indispensable in surviving the current humanitarian catastrophe.ConclusionIn the discussion we point out that the current crisis magnified the pre-existing challenges as the providers approach toward overcoming them was already largely present before the crisis (just on a different scale). The underlying fragility of resources was a constant since OAT inception in Ukraine. Historically, providers in Ukraine operated in a system that was under-funded in the absence of solid governmental funding for OAT programs, yet they came up with solutions which required ingenuity that they took pride in. This gives hope that addiction treatment in Ukraine and OAT programs will not be casualties of this humanitarian crisis and providers and their patients will persevere.

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Section: Discussionmentioning

confidence: 83%

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

Dellamura,

Meteliuk,

Fomenko

et al. 2024

Front. Public Health

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“…Until 2016, OAT in the form of methadone was exclusively provided at governmental clinics. The administration of methadone was primarily conducted as a daily, directly supervised therapy; however, due to the onset of the COVID-19 pandemic and the ongoing war in Ukraine, there has been a notable expansion in the availability of take-home dosing for methadone [17,18]. This change has allowed individuals to have more flexibility in managing their treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Another development in the OAT landscape occurred in 2021 with the introduction of methadone in Ukrainian prisons, aiming to address the needs of incarcerated individuals struggling with opioid addiction. More relaxation of THD during the 2022 invasion of Ukraine by Russia also occurred [20], and further accelerated the adaptation of new models of OAT delivery [17,18,20,21]. As OAT delivery continues to be in flux, understanding patient preferences can inform emerging models of care and scale-up.…”

Section: Introductionmentioning

confidence: 99%

Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey

Bromberg,

Madden,

Fraenkel

et al. 2024

PLOS Glob Public Health

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Scaling up opioid agonist therapies (OAT) is the most effective strategy to control combined HIV and opioid epidemics, especially in Eastern Europe and Central Asia (EECA), where HIV incidence and mortality continue to increase. Patient concerns about OAT, however, have undermined scale-up. The objective of this study is to understand Ukrainian opioid use disorder patient preferences about OAT to guide the development of an evidence-informed decision aid for clinical decision-making. We conducted a conjoint-based choice (CBC) survey. Participants were asked to about their preferences relating to 7 attributes of OAT (cost, dosing frequency, concerns about withdrawal symptoms, adverse side effects, improvements in quality of life, precipitation of withdrawal and legislative requirements to be registered as a drug dependent person) and 20 attribute levels for receiving OAT under differing potential treatment constraints. Data were analyzed using Hierarchical Bayesian models. Using respondent-driven sampling and random sampling, we recruited 2,028 people who inject drugs with opioid use disorder. Relative importance (RIS) and partial-worth utility scores (PWUS) were used to assess preferences for attributes and thresholds within each attribute. Cost and dosing frequency were the most important attributes (RIS = 39.2% and RIS = 25.2%, respectively) to potential patients, followed by concerns about withdrawal symptoms (RIS = 10.8%), adverse side effects (RIS = 9.0%), quality-of-life improvement (RIS = 7.5%), precipitation of euphoria (5.2%) and requirement to be registered as a drug- dependent person (RIS = 3.1%). The monthly cost-threshold for willingness-to-pay was 1,900 UAH ($70 USD). In Ukraine, where both governmental and private OAT clinics have emerged and provide markedly different delivery strategies, preferences are mostly driven by out-of-pocket expenses, despite many patients being willing to pay for OAT. Programmatic demands (flexibility and ease of acquiring medications) remain an important consideration while for a minority, clinical concerns about withdrawal symptoms, adverse side effects and OAT impact on life play a smaller role.

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“…The author correctly restates Ukraine's Ministry of Health's (MoH) efforts and rapid responses taken as Russia invaded Ukraine, 1 including rapidly transferring medications for opioid use disorder (MOUD) to safer locations, manually distributing MOUD to sites inaccessible by transportation routes and allowing a 30-day supply of MOUD. 2 , 3 These rapid, unprecedented responses were the result of a functioning and responsible government that urgently passed legislation and enacted new guidelines to meet public health needs. We commend these efforts.…”

mentioning

confidence: 99%

“…All content published related to innovations in collaboration between governmental and private MOUD clinics in Kharkiv, however, remains accurate. 3 It represents a specific, but critical time in the war and is supported by extensive interviews, participation on regular MoH conference calls, in-depth review of Kharkiv data, and weekly Network for the Improvement of Addiction Treatment (NIATx) coaching calls. As MoH enacted MOUD policy, NIATx has collaborated to help guide MOUD scale-up since 2014.…”

mentioning

confidence: 99%

Medications for opioid use disorder during the war in Ukraine: a more comprehensive view on the government response—Authors’ reply

Bromberg

Madden

Meteliuk

et al. 2023

The Lancet Regional Health - Europe

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Medications for opioid use disorder during war in Ukraine: Innovations in public and private clinic cooperation

Cited by 14 publications

References 6 publications

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey

Medications for opioid use disorder during the war in Ukraine: a more comprehensive view on the government response—Authors’ reply

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