Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Abstract

Objective To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. Methods This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. Results Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. Conclusions MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

North Carolina Medicaid System Perspectives on Substance Use Disorder Treatment Policy Changes during the COVID-19 Pandemic

“…The present study expands prior work in other states by adding findings from within a sample of NC's Medicaid system, including perspectives from the state, LME/MCOs, providers, and beneficiaries. Consistent with several prior studies 25-28 and in contrast to another, 29 these changes were generally well received by providers and patients in this study. In addition, these positive opinions were shared by representatives of state health agencies and LME/MCOs, suggesting a broad approval of the policy changes.…”

“…Given the range of COVID-related SUD policy changes that were implemented, understanding the experiences of people involved with those changes will be critical to discussions about any permanent policy changes. To date, few studies have described provider or patient perspectives regarding the impacts of COVID-19 on OUD treatment 25-29 . The present study expands prior work in other states by adding findings from within a sample of NC's Medicaid system, including perspectives from the state, LME/MCOs, providers, and beneficiaries.…”

“…To date, few studies have described provider or patient perspectives regarding the impacts of COVID-19 on OUD treatment. [25][26][27][28][29] The present study expands prior work in other states by adding findings from within a sample of NC's Medicaid system, including perspectives from the state, LME/MCOs, providers, and beneficiaries. Consistent with several prior studies [25][26][27][28] and in contrast to another, 29 these changes were generally well received by providers and patients in this study.…”

Pharmacist‐delivered comprehensive medication management in a substance use disorder clinic, an 18‐month descriptive study

“…5 Despite great efforts made to mitigate the opioid overdose crisis, barriers preventing treatment still exist for patients with OUD including lack of healthcare access in rural areas, buprenorphine and methadone prescribing regulations, and stigma from the community. [6][7][8] While methadone can only be dispensed at an opioid treatment program (OTP), buprenorphine is prescribed by a licensed physician through an office-based opioid treatment (OBOT) program for patients to take outside of an OTP setting. 9 Access to medications for OUD (MOUD) remains challenging, especially in rural areas.…”

Doing Our Best in a Broken System: The Urgent Need for Expansion of Medication for Opioid Use Disorder Treatments in the United States

“…Despite calls for more significant regulatory changes to make medications for OUD more accessible during a global pandemic, 3 only gradual changes have occurred and are not widely adopted 4–6 . Even as the drug supply has become more toxic with the proliferation of xylazine, 7 and as we see overdoses rising disproportionately among minoritized communities, 8 little has changed.…”