Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada

Abstract

IMPORTANCE Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. OBJECTIVE To compare timely access to methadone initiation in the US and Canada during COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. EXPOSURES Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). MAIN OUTCOMES AND MEASURES Proportion of clinics accepting new patients and days to first appointment. RESULTS Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%)during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001).Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.

The COVID-19 pandemic and the health of people who use illicit opioids in New York City, the first 12 months

“…For example, early telemedicine programs for buprenorphine were implemented alongside expanded take-home methadone ( Tofighi et al, 2021 ). Based on our results, we would cautiously suggest that policies and procedures surrounding MOUD in NYC have been a critical part of the response and have helped avoid even larger increases in OD mortality seen elsewhere in the country where access to methadone may have been more limited ( Joudrey et al, 2021 ). The telehealth model, coupled with increased low-threshold access and delivery of prescription methadone and buprenorphine could be widely implemented beyond the COVID-19 pandemic, saving time and resources, and reducing stigma associated with the clinic system ( Bennett & Elliott, 2021 ; Brothers, Viera, & Heimer, 2021 ).…”

Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis

“…[6][7][8][9][10][11] One noteworthy finding was that our study site maintained similar rates of treatment initiation (in terms of unchanged new patient intakes) before and after the onset of the COVID-19 pandemic, which differs from national trends observed in Canada and the U.S. suggesting decreased availability of OTP treatment during COVID-19. 17 In terms of individual clinical outcomes, other studies to our knowledge have directly assessed outcomes among individuals newly started on take-homes under the new regulations, aside from one study from North Carolina which demonstrated no increase in self-reported diversion/misuse. 11 Our finding that new take-homes were not associated with an increase in overall deaths mirrors the findings of a state-level study of methadone-involved fatalities in Connecticut, which found no increase in fatalities despite increased take-home prescribing across the state's eight OTPs.…”

Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

“…The lack of access to care has been especially acute for patients with chronic pain problems and/ or substance use disorders (Jacka et al, 2021;Kedia et al, 2021;Narayan and Balkrishnan, 2021). The lack of access to medicallyassisted care for patients with opioid use disorder during the COVID-19 pandemic has been particularly severe (Jacka et al, 2021;Joudrey et al, 2021). These factors have probably resulted in a well-documented surge in the abuse of street opioids and their many attendant problems (CDC, 2021;Manchikanti et al, 2021).…”

“…In light of these findings, there is clearly a need for further research on safety and efficacy of kratom and its active compounds. With regard to COVID-19, it is well documented that the pandemic has decreased access to medically-assisted treatment for patients with opioid use disorder (Joudrey et al, 2021;Narayan and Balkrishnan, 2021), a situation that leads to an increase in the use of kratom (Prevete et al, 2021). Even though COVID-19 is primarily viewed as a pulmonary disease, infected patients often exhibit symptoms of pain, lethargy and depression.…”