Opioid agonist treatment and patient outcomes during the COVID‐19 pandemic in south east Sydney, Australia

Abstract

Introduction In early 2020, many services modified their delivery of opioid treatment in response to the COVID‐19 pandemic, to limit viral spread and maintain treatment continuity. We describe the changes to treatment and preliminary analysis of the association with patients' substance use and well‐being. Methods A pre‐post comparison of treatment conditions and patient self‐reported outcomes using data extracted from electronic medical records in the 5 months before (December 2019–April 2020) and after (May 2020–September 2020) changes were implemented in three public treatment services in South Eastern Sydney Local Health District. Results Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out of treatment. In the ‘post’ period there was significantly more use of depot buprenorphine (12–24%), access to any take‐away doses (TAD; 24–69%), access to ≥6 TAD per week (7–31%), pharmacy dosing (24–52%) and telehealth services. There were significant reductions in average opioid and benzodiazepine use, increases in cannabis use, with limited group changes in social conditions, or quality of life, psychological and physical health. At an individual level, 22% of patients reported increases in their use of either alcohol, opioids, benzodiazepines or stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates increases in substance use were associated with higher levels of supervised dosing. Discussion and Conclusions These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more TAD and significant increases in substance use. Limitations are discussed and further evaluation is needed.

Evaluating interventions to facilitate opioid agonist treatment access among people who inject drugs in Toronto, Ontario during COVID-19 pandemic restrictions

“…A pre-post analysis of 194 methadone patients in Spokane, Washington found that patients received, on average, an additional 41.4 days’ worth of take-home doses over the three months following the guidelines versus the preceding three months ( Amram et al, 2021 ). Similar to Ontario, the Australian government released national guidelines emphasizing virtual visits, less frequent urine drug screening, and reducing observed dosing for OAT patients during the pandemic ( Lintzeris et al, 2021 ). Based on three public treatment services in Sydney, Australia, Lintzeris and colleagues found that the proportion of OAT patients receiving any take-home methadone or sublingual buprenorphine doses increased considerably in the four months after guideline-based service changes (67% or 210/314) versus the preceding four-month period (23% or 86/378) ( Lintzeris et al, 2021 ).…”

“…Similar to Ontario, the Australian government released national guidelines emphasizing virtual visits, less frequent urine drug screening, and reducing observed dosing for OAT patients during the pandemic ( Lintzeris et al, 2021 ). Based on three public treatment services in Sydney, Australia, Lintzeris and colleagues found that the proportion of OAT patients receiving any take-home methadone or sublingual buprenorphine doses increased considerably in the four months after guideline-based service changes (67% or 210/314) versus the preceding four-month period (23% or 86/378) ( Lintzeris et al, 2021 ). Lastly, in Ukraine, the national Ministry of Health released interim guidance in March 2020 relaxing an existing requirement of six months of sobriety for OAT patients to receive take-home doses ( Meteliuk et al, 2021 ).…”

Response to Steele and Acheson

“…The experience from COVID has demonstrated that many (but not all) clients can have increased TADs for methadone and sublingual buprenorphine without significant harms [2,8,9]. It remains to be seen whether these changes will be maintained as COVID pandemic restrictions gradually subside over time.…”

“…overdoses from diverted TADs). To date, we have only seen interim evaluations from the first wave of COVID in a number of counties [2,8,9], and it is incumbent upon our sector to evaluate longer-term experiences to plan future service models. While some services have embedded these changes into revised service models [10], there is no consensus among policy makers or service providers as to the way forward.…”

“…But our sector is not incapable of change, and we can rethink our models of care to be less reliant on supervised dosing-through the use of increased use of TADs and depot buprenorphine options, that will go a long way to redress many of the challenges for clients. NICHOLAS LINTZERIS 1,2,3 , LOUISA JANSEN 1,3…”