Take-Home Dosing Experiences among Persons Receiving Methadone Maintenance Treatment During COVID-19

Figgatt, Mary; Salazar, Zach; Day, Elizabeth; Vincent, Louise; Dasgupta, Nabarun

doi:10.1101/2020.08.31.20185249

Cited by 14 publications

(20 citation statements)

References 12 publications

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“…Changes in OST provision and assertive outreach were experienced positively, but there were indications remote service provision and decreased privacy in service access may present barriers for PWID. Work from Scotland has highlighted concerns regarding unsupervised consumption, including pressures to divert medication ( Schofield et al, 2021 ), but as in recent quantitative work from the US ( Figgatt et al, 2021 ) there were few reports of OST diversion in the present study. In the North-West of England, COVID-19 restrictions resulted in large reductions in NSP usage and the number of needles distributed ( Whitfield et al, 2020 ), but this was not observed in our sample.…”

Section: Discussionmentioning

confidence: 56%

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Kesten¹,

Holland²,

Linton³

et al. 2021

International Journal of Drug Policy

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Background : People who inject drugs (PWID) are a high-risk group for COVID-19 transmission and serious health consequences. Restrictions imposed in the UK in response to the pandemic led to rapid health and housing service alterations. We aimed to examine PWID experiences of: 1) challenges relating to the COVID-19 public health measures; 2) changes to opioid substitution therapy (OST) and harm reduction services; and 3) perceived effects of COVID-19 on drug use patterns and risk behaviour. Methods : Telephone semi-structured interviews were conducted with 28 PWID in Bristol, Southwest of England. Analysis followed a reflexive thematic analysis. Results : Concern about COVID-19 and adherence to public health guidance varied. Efforts made by services to continue providing support during the pandemic were appreciated and some changes were preferred, such as less frequent OST collection, relaxation of supervised consumption and needle and syringe programmes (NSP) home delivery. However, remote forms of contact were highlighted as less beneficial and more difficult to engage with than in-person contact. Public health guidance advising people to ‘stay home’ led to increased isolation, boredom, and time to ruminate which impacted negatively on mental health. Lockdown restrictions directly impacted on sources of income and routine. Changes in drug use were explained as a consequence of isolation and fewer interactions with peers, problems accessing drugs, reduced drug purity and reduced financial resources. Conclusion : This study captures the significant impacts and challenges of the COVID-19 pandemic on the lives of PWID. While rapid adaptations to service delivery to help mitigate the risks of COVID-19 were appreciated and some changes such as relaxation of supervised daily OST consumption were viewed positively, barriers to access need further attention. Going forwards there may be opportunities to harness the positive aspects of some changes to services.

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Section: Discussionmentioning

confidence: 56%

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Kesten¹,

Holland²,

Linton³

et al. 2021

International Journal of Drug Policy

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“…To our knowledge, this study is among a very few to report direct patient experience with policy changes in MOUD access during COVID. A telehealth satisfaction survey was conducted in one Rhode Island provider setting [ 35 ], a survey study of North Carolina patients in three methadone clinics was reported [ 36 ], and a very small, non-peer reviewed study in one San Francisco methadone clinic with 10 providers and 20 patients reported views about methadone take-home dosing [ 37 ]. The North Carolina study found that take-home doses increased from pre-COVID periods to the time of the study (summer 2020) from 56–82% to 78–100%, though notably, the clinic-level percent of patients receiving a week or longer (>6 days) ranged from 11–56%.…”

Section: Discussionmentioning

confidence: 99%

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Meyerson

Bentele²,

Russell³

et al. 2022

PLoS ONE

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Objective To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. Methods This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. Results Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. Conclusions MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

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“…Finally, our findings highlight the tension at play between patient versus clinician preferences about care delivery. Studies of methadone clinics have found that while loosened federal restrictions associated with the COVID-19 pandemic resulted in increased take-home doses for many patients, this varied by clinic [37,38], suggesting that prescribers and program staff likely used discretion in deciding which patients could receive more flexible care. Additionally, patient "stability"-determined partially by the absence of ongoing substance use and other factors like "confidence" that a patient would take their medication as prescribed-impacted the likelihood that methadone programs would allow for takehome dosing [39].…”

Section: Discussionmentioning

confidence: 99%

Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

et al. 2021

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Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. Methods We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. Results Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients’ access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients’ access to treatment via telehealth may hinge on clinician perceptions of patient “stability” rather than patient preferences. Conclusions Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed “unstable” via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.

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Take-Home Dosing Experiences among Persons Receiving Methadone Maintenance Treatment During COVID-19

Cited by 14 publications

References 12 publications

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID

Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

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