Opioid Use Disorder Treatment Disruptions during the COVID-19 Pandemic and Other Disasters: A Scoping Review Addressing Dual Public Health Emergencies

Abstract

Background: During public health emergencies, disruptions to social landscapes and amplification of inequities for people with opioid use disorder raise important questions about reducing harms and providing treatment accountability to support this population during disasters including COVID-19. This research aims to a) identify how disasters impact persons with opioid use disorder (OUD) and their access to healthcare, with specific attention to COVID-19, and b) inform ongoing responses to the pandemic and future disaster-mitigation plans related to healthcare disruptions affecting persons with opioid use disorder (PWOUD). Methods: We conducted knowledge synthesis based on a 6-stage scoping review framework methodology. Stakeholder consultation was completed using a Nominal Group Technique with two groups, each composed of including providers in primary, emergency and community-based care. One group (n=7) represented voices from urban services, and the other (n=4) Indigenous contexts allowing for attention to healing the whole person, beyond OAT. Results: 61 scientific journal articles and 72 grey literature resources were included after full-text screening. Stakeholder NGT process revealed three contextual factors affecting system and service accountability for responsive OUD care during disaster-driven disruptions: (1) disasters focus attention on single risks and generalized solutions; (2) data-poor decision-making perpetuates stigma and produces policy inattentive to social determinants of health; and (3) harm reduction and contextually-tailored care prepare a system for future disasters. Conclusion: COVID-19 public health efforts require a coordinated systemic approach to serving PWOUD, based on accountability to patients and support for providers.

The Impact of the COVID-19 Pandemic on Opioid-Related Harm in Ontario

“…People experiencing homelessness or housing instability 5,11,12 Men and individuals between the ages of 20-49 2,5 Neighbourhoods with higher ethno-cultural diversity (based on data from Ontar-…”

“…The Impact of the COVID-19 Pandemic on Opioid-Related Harm in Ontario io) 10 and, people in BIPOC communities (based on international data) 13,14 People experiencing incarceration or who have been recently released from prison 4,5,12 These priority groups require specific attention when considering public health measures aimed at addressing increased rates of opioid-related harm during COVID-19; however, this is not an exhaustive list. 4,12 It is vital to consider the intersection between these and other SDOH, such as stigma surrounding drug use and other structural barriers to receiving adequate healthcare, when evaluating and addressing the sociodemographic disparities in opioid-related harm that have emerged during the COVID-19 pandemic. 12,15…”

“…4,12 It is vital to consider the intersection between these and other SDOH, such as stigma surrounding drug use and other structural barriers to receiving adequate healthcare, when evaluating and addressing the sociodemographic disparities in opioid-related harm that have emerged during the COVID-19 pandemic. 12,15…”

“…15 Continue providing telemedicine-based OAT appointments, where possible (see additional considerations on telemedicine-based addiction treatment, below). 12,15 Support access to OAT through primary care, emergency departments, hospitals, and harm reduction settings. 15,31 Ensure access to diverse range of OAT options to meet PWUD's needs, including methadone, buprenorphine (including extended-release and implant formulations), slow-release oral morphine, and injectable OAT (high-dose injectable hydromorphone, diacetylmorphine).…”

“…32 Promote and facilitate information sharing between service providers to ensure consistency of dosing and treatment plans. 12,15 Provide safe medication storage options such as lockboxes for medications at home. 15,33 Provide medication delivery services or pickup options with minimal contact to reduce the risk of SARS-CoV-2 transmission.…”