Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy

Krawczyk, Noa; Rivera, Bianca; Levin, Emily; Dooling, Bridget C.E.

doi:10.1016/s2468-2667(23)00023-3

Cited by 39 publications

(33 citation statements)

References 44 publications

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“…Continued efforts to increase COVID-19 flexibilities for methadone take-homes and facilitating the initiation of buprenorphine via telehealth, which has been found to facilitate initiation and retention in MOUD, are strategies that can help facilitate long-term outcomes in these treatments. 65,66 Expanding methadone to other treatment settings, including mobile health vans (which have recently launched in NY) 67,68 and office-based practices as is done in many non-US settings, 69 and which has been proposed by recent legislation, may also improve MMT access and continuity. Importantly, ensuring connections to harm reduction programs is also critical for ensuring reduced overdose among this population.…”

Section: Discussionmentioning

confidence: 99%

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

Krawczyk,

Lim,

Cherian

et al. 2023

Preprint

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Background and AimsOffering medications for opioid use disorder (MOUD) in carceral settings can significantly reduce overdose risk. However, it is unknown whether and to what extent individuals in U.S. jail settings continue MOUD once they leave incarceration, and what factors influence treatment continuity.DesignRetrospective cohort study of linked jail-based electronic health records and community OUD treatment claims.SettingNew York City JailParticipantsIncarcerations of individuals with OUD discharged from jail to the community between May 1, 2011 and December 31, 2017ComparatorsReceiving vs. not receiving MOUD (methadone or buprenorphine) at the time of release from jailMeasurementsWe measured continuity of community-based MOUD treatment within one month of release, among those with and without MOUD during release from jail. We tested for effect modification based on MOUD receipt prior to incarceration and assessed factors associated with treatment discontinuation upon re-entry.FindingsOf 28,298 eligible incarcerations, 52.8% received MOUD at release. 30% of incarcerations with MOUD had a community-based MOUD claim within 30 days of release, compared to 7% of incarcerations without MOUD (Risk Ratio: 2.62 (2.44-2.82)). Most (69%) of those with MOUD claims prior to incarceration who received in-jail MOUD continued MOUD in the community, compared to only 9% of those without prior MOUD. Among incarcerations with MOUD at release, those who were younger, Non-Hispanic Black and with no history of MOUD treatment were less likely to continue treatment following release.ConclusionsMOUD maintenance in jail is strongly associated with MOUD continuity in the community upon release. Still, findings highlight a continued gap in MOUD upon-reentry, especially among those who initiate MOUD in jail. In the wake of worsening overdose deaths and troubling disparities, improving continuty of evidence-based care among this population must be an urgent policy priority.

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Section: Discussionmentioning

confidence: 99%

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

Krawczyk,

Lim,

Cherian

et al. 2023

Preprint

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“…We adapted the search strategy from a related review on the impact of pandemic regulatory changes on methadone treatment. 17 We searched PubMed and PsycInfo with combinations of the following terms: COVID-19, pandemic, buprenorphine, telehealth, opioid treatment program/OTP, opioid-related disorder, and opiate substitution treatment (see Supplemental Table 1 for full search strategy). We also reviewed reference lists from included articles for relevant studies not identified by the database search.…”

Section: Methodsmentioning

confidence: 99%

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

Krawczyk¹,

Rivera²,

King³

et al. 2023

Preprint

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Buprenorphine is a highly effective treatment for opioid use disorder and a critical tool for addressing the worsening U.S. overdose crisis. However, multiple barriers to treatment, including stringent federal regulations, have historically made this medication hard to reach for many who need it. In 2020, under the COVID-19 Public Health Emergency, federal regulators substantially changed access to buprenorphine by allowing prescribers to initiate patients on buprenorphine via telehealth without first evaluating them in person. As the Public Health Emergency is set to expire in May of 2023, Congress and federal agencies can leverage extensive evidence from studies conducted during the wake of the pandemic to make evidence-based decisions on the regulation of buprenorphine going forward. To aid policy makers, this review synthesizes and interprets peer-reviewed research on the effect of buprenorphine flexibilities on uptake and implementation of telehealth, and its impact on OUD patient and prescriber experiences, access to treatment and health outcomes. Overall, our review finds that many prescribers and patients took advantage of telehealth, including the audio-only option, with a wide range of benefits and few downsides. As a result, federal regulators, including agencies and Congress, should continue non-restricted use of telehealth for buprenorphine initiation.

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“…To this end, the objective of this systematic review was to synthesize the evidence on providers’ experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. Though there is a substantial body of research examining the impact of COVID-19-related changes to substance use treatment (e.g., Bouck et al, 2022 ; Garg et al, 2022 ; Krawczyk et al, 2022a ; Lintzeris et al, 2022 ; May et al, 2022 ), this is, to our knowledge, the first systematic review of international scope to focus on providers’ experiences. Knowledge of these experiences is necessary to understand the effects of increased flexibility in prescribing take-home medications for opioid use disorder during COVID-19, to explain differences in the uptake of regulatory changes, and to inform post-pandemic policies and guidelines.…”

Section: Introductionmentioning

confidence: 99%

Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review

Adams,

Blawatt,

MacDonald

et al. 2023

International Journal of Drug Policy

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Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy

Cited by 39 publications

References 44 publications

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review

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