Shifting Medication Treatment Practices in the COVID-19 Pandemic: A Statewide Survey of Pennsylvania Opioid Treatment Programs

Krawczyk, Noa; Maniates, Hannah; Hulsey, Eric; Smith, Jennifer S.; DiDomenico, Ellen; Stuart, Elizabeth A.; Saloner, Brendan; Bandara, Sachini

doi:10.1097/adm.0000000000000981

Cited by 18 publications

(30 citation statements)

References 31 publications

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“…21 Similarly, 66% of OTP directors surveyed in Pennsylvania noted they extended take-home supplies following the new flexibilities . 22 In a survey of all 8 Connecticut OTPs, directors reported that the number of patients receiving one or no take-home doses decreased from 37.5% to 9.6% (Brothers, 2021). 23 Three surveys asked patients about increased take-homes: In a survey of 104 OTP patients in North Carolina, 91.6% said they received some take-homes following the pandemic flexibilities relative to 68.3% who had received take-homes prior to the pandemic (Figgatt, 2021).…”

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

“…23 Similarly, over 90% of OTPs in Pennsylvania noted less than half of their patients received 14-day take-homes, and 95% noted less than a quarter of their patients received 28-day take-homes . 22 No studies identified differences in take-home trends by provider characteristics (Lavender 2022, Krawczyk 2022). 22,31 Findings suggest that even under a more permissive policy, providers will not necessarily permit all patients to receive maximum amounts of take-home supplies.…”

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

“…22 No studies identified differences in take-home trends by provider characteristics (Lavender 2022, Krawczyk 2022). 22,31 Findings suggest that even under a more permissive policy, providers will not necessarily permit all patients to receive maximum amounts of take-home supplies.…”

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

“…31 Many expressed concerns about how take-home dosing would reduce revenue , Goldsamt, 2021, Hunter, 2021). 22,31,33,34 Some noted concerns around legal liability for potential overdose or diversion of methadone, which made them apprehensive about take-home dosing long-term , Hunter, 2021, Madden, 2021). 31,34,35 These findings suggest provider uncertainty about the regulations, consequences for patients, and finances depressed uptake.…”

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

“…27 Some studies found that providers were willing to provide increased take-homes indefinitely: In a survey of OTP directors in Pennsylvania, 79% agreed with maintaining more flexibility on take-home length . 22 Some providers believed that criteria for determining take-home doses prior to the pandemic were too strict, placing limits on providers' clinical judgment (Treitler, 2022). 36 Many were supportive of retaining the flexibilities to improve access to and quality of care (Suen, 2022), 32 or worried about returning to a more restrictive schedule if the pandemic flexibilities were rescinded (Treitler, 2022).…”

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

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Synthesizing evidence on the impacts of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for U.S. federal policy

Krawczyk¹,

Rivera²,

Levin

et al. 2022

Preprint

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As the U.S. faces a worsening overdose crisis, improving access to evidence-based treatment for opioid use disorder (OUD) remains a central policy priority. Federal regulatory changes in response to the COVID-19 pandemic significantly expanded flexibilities on take-home doses for methadone treatment for OUD. These changes have fueled critical questions about the impact of new regulations on OUD outcomes, and the potential health impact of permanently integrating these flexibilities into treatment policy going forward. To aide US policy makers as they consider implementing permanent methadone regulatory changes, we conducted a review synthesizing peer-reviewed research evidence on the impact of the COVID-19 methadone-take-home flexibilities on methadone program operations, OUD patient and provider experiences, and patient health outcomes. We interpret this evidence in the context of the federal rulemaking process and discuss avenues by which these important findings can be incorporated and implemented into U.S. substance use treatment policy going forward.

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Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

Section: B Findings and Implications For Federal Regulatorsmentioning

confidence: 99%

See 3 more Smart Citations

Synthesizing evidence on the impacts of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for U.S. federal policy

Krawczyk¹,

Rivera²,

Levin

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

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Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

et al. 2023

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ImportanceIn March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures.ObjectiveTo assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups.Design, Setting, and ParticipantsInterrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.ExposureOn March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients.Main Outcome MeasuresMonthly methadone-involved overdose deaths.ResultsFrom January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study’s 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, −0.55 [95% CI, −0.95 to −0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (−0.42 [95% CI, −0.68 to −0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, −0.27 [95% CI, −1.13 to 0.59]; Hispanic women, 0.29 [95% CI, −0.46 to 1.04]; White men, –0.08 [95% CI, −1.05 to 0.88]; and White women, −0.43 [95% CI, −1.26 to 0.40]).Conclusions and RelevanceIn this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

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Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs – Baltimore, Maryland, 2014–2022

Feder,

Patel,

Buresh

et al. 2023

Drug and Alcohol Dependence

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Shifting Medication Treatment Practices in the COVID-19 Pandemic: A Statewide Survey of Pennsylvania Opioid Treatment Programs

Cited by 18 publications

References 31 publications

Synthesizing evidence on the impacts of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for U.S. federal policy

Synthesizing evidence on the impacts of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for U.S. federal policy

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs – Baltimore, Maryland, 2014–2022

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