Patients’ perceptions of self-administered dosing to opioid agonist treatment and other changes during the COVID-19 pandemic: a qualitative study

Abstract

ObjectivesDuring the COVID-19 pandemic, addiction treatment services received official guidance asking them to limit face-to-face contact with patients and to prescribe opioid agonist treatment (OAT) medication flexibly. With the aim for most patients to receive take-home supplies for self-administration rather than attendance for observed daily dosing.DesignThis was a theory-driven, clinically applied qualitative study, with data for thematic analysis collected by semi-structured, audio-recorded, telephone interviews.ParticipantsTwenty-seven adults (aged ≥18 years) enrolled in sublingual (tablet) buprenorphine and oral (liquid) methadone OAT.SettingCommunity addictions centre in the London Borough of Lambeth operated by South London and Maudsley NHS Trust.ResultsThree major themes were identified: (1) dissatisfaction and perceived stigma with OAT medication dispensing arrangements before the pandemic; (2) positive adaptations in response to COVID-19 by services; (3) participants recommended that, according to preference and evidence of adherence, OAT should be personalised to offer increasing medication supplies for self-administration from as early as 7 days after commencement of maintenance prescribing.ConclusionsIn an applied qualitative study of patients enrolled in OAT during the COVID-19 pandemic, participants endorsed their opportunity to take medication themselves at home and with virtual addiction support. Most patients described a preference for self-administration with increased dispensing supplies, from as early as 7 days into maintenance treatment, if they could demonstrate adherence to their prescription.

The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review

“…2021 Yes No S32 Russell et al, 2021 [ 100 ] Canada "to understand how service disruptions during COVID-19 may have affected PWUD" (p. 2) Qualitative study May 2020 Jul. 2020 No Yes S33 Schofield et al, 2022 [ 101 ] United Kingdom (Scotland) To explore "the impacts of COVID-19 related changes on the availability and uptake of health and care services, particularly harm reduction, treatment, recovery, and general healthcare services, among PWUD in Scotland during the pandemic" (p. 2) Qualitative study May 2020 Nov. 2020 No Yes S34 Scott et al, 2023 [ 102 ] United Kingdom (England) To investigate how people with OUD experienced changes to substance use treatment during COVID-19 and to explore their views on improving OAT delivery Qualitative study NR NR No Yes S35 Suen et al, 2022/Wyatt et al, 2022 [ 104 ] United States "to describe the MOUD treatment experiences of patients and providers at an OTP [opioid treatment program] in San Francisco, California, to inform [post-COVID-19] research and policy" (p. 1148) Qualitative study Aug. 2020 Nov. 2020 No Yes S36 University of Bath et al, 2020, 2021 [ 106 ] England "to understand how people in receipt of OST [opioid substitution treatment] in rural areas have experienced the pandemic changes [to treatment]." (p. 2) Qualitative study NR Mar.…”

Superiority and cost-effectiveness of monthly extended-release buprenorphine versus daily standard of care medication: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial

“…There can be several reasons why a patient leaves SoC maintenance—but a notable one is that pharmacy dosing is experienced as stigmatising 20 Some patients do stay in maintenance treatment for many months—but a sizeable minority does not achieve or maintain a clinically significant reduction in their opioid use. For example, in a cohort of 7719 patients in England enrolled continuously in the SoC for over five years, 15% were using heroin on about half of the days each month at each bi-annual assessment.…”