Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program

Peavy, K. Michelle; Darnton, James; Grekin, Paul; Russo, Monica Lo; Green, Caleb J. Banta; Merrill, Joseph O.; Fotinos, Charissa; Woolworth, Steve; Soth, Sean; Tsui, Judith I.

doi:10.1007/s10461-020-02887-1

Cited by 56 publications

(66 citation statements)

References 26 publications

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“…This rise in the demand for sedatives/hypnotics may be related to stressful situation of the COVID-19 pandemic and its consequences. Survey results also suggest increased use of prescription opioids, perhaps for similar reasons, and changes in services may be needed (35, 36). Canada, Australia, United Kingdom and Scotland facilitated pharmacy-based methadone-dispensing programs as prescribing opioid-related medications increased (36).…”

Section: Discussionmentioning

confidence: 99%

A global survey on changes in the supply, price and use of illicit drugs and alcohol, and related complications during the 2020 COVID-19 pandemic

Farhoudian

Radfar

Rafei

et al. 2020

Preprint

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Background and aims: COVID-19 has infected more than 13 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing and ′lockdown′ measures have affected drug and alcohol supply chains and subsequently their availability, price and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4th, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals′ perceived changes in drug and alcohol supply, price, use pattern and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered ″decreased″ or ″increased″, percentage of those who were in majority is reported in the parenthesis) a decrease in drug supply (69.0%), and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to SUDs. Key words: COVID-19, pandemic, alcohol, drug, substance use disorder, supply, price.

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Section: Discussionmentioning

confidence: 99%

A global survey on changes in the supply, price and use of illicit drugs and alcohol, and related complications during the 2020 COVID-19 pandemic

Farhoudian

Radfar

Rafei

et al. 2020

Preprint

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“…Looking to the future, several authors suggest that the COVID-19 pandemic response has provided an opportunity for much needed change in the delivery of HR services [ 34 , 35 , 44 ]. Innovations and regulatory changes, such as flexible OST dosing and dispensing, made during the COVID-19 pandemic need to be evaluated and, if effective in a non-pandemic situation, sustained into the future [ 10 , 31 , 44 , 45 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors highlighted the important role of pharmacies in delivering HR interventions during a pandemictype situation if other services become unavailable [2, [43][44][45]. However, at such times, pharmacies may have reduced opening hours [31].…”

Section: Role Of Pharmaciesmentioning

confidence: 99%

Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response

et al. 2020

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Background People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. Methods A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. Results In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. Conclusions This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.

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“…As a preventative measure to reduce COVID-19 spread, all international and national published guidelines advised limited but effective ways regarding how to initiate treatment, support stabilization and maintenance and continue to provide harm reduction measures to treatment-seeking and other populations with substance use problems (Farhoudian, et al, 2020; Marsden, et al, 2020). These recommendations often included extending flexibility in OAT services with reduced supervision of doses and increased home delivery (Dunlop et al, 2020; Peavy et al, 2020). Another step taken to adjust to the present situation included expanding telemedicine and teletherapy services (Farhoudian, Baldacchino, et al, 2020; Knopf, 2020; Elizabeth A Samuels et al, 2020; Mellis et al, in press).…”

Section: Discussionmentioning

confidence: 99%

Reorganization of Substance Use Treatment and Harm Reduction Services during the COVID-19 Pandemic: A Global Survey

Radfar

Jong

Farhoudian

et al. 2020

Preprint

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Background: The COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health response is categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. 57% of overdose prevention interventions and 81% of outreach services also having been negatively impacted. Conclusions: Participants reported that SUD treatment and harm reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we provide a series of recommendations to support countries to be prepared more efficiently for future waves or similar pandemics to 1) help policymakers generate business continuity plans, 2) maintain the use of evidence-based interventions for people with SUDs, 3) be prepared for adequate medication supplies, 4) integrate harm reduction programs with other treatment modalities and 5) have specific considerations for vulnerable groups such as immigrants and refugees.

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Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program

Cited by 56 publications

References 26 publications

A global survey on changes in the supply, price and use of illicit drugs and alcohol, and related complications during the 2020 COVID-19 pandemic

A global survey on changes in the supply, price and use of illicit drugs and alcohol, and related complications during the 2020 COVID-19 pandemic

Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response

Reorganization of Substance Use Treatment and Harm Reduction Services during the COVID-19 Pandemic: A Global Survey

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