ABSTRACT
Federal regulations for THDs changed during the COVID-19 pandemic, allowing OTPs to initiate or extend THDs.2 Emerging data suggest increasing access to THDs does not increase adverse events.3-5 In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) enacted exemptions allowing increased THDs to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk by decongregating OTP settings. FINANCIAL STRUCTURE IMPACT In a multisite, mixed methods study examining the experiences and outcomes of individuals with opioid use disorder who received increased THDs (study 1), we noted that the financial structuring of one OTP influenced the implementation of regulations during COVID-19. In February 2020, 88 incarcerated men were enrolled in the MMT program. Because of COVID-19, admissions were postponed until October 2020. [...]research is needed to understand the impact of varied state OTP regulations among persons released from prison on MMT.
ABSTRACT
Importance: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. Objective: To compare timely access to methadone initiation in the US and Canada during COVID-19. Design, Setting, and Participants: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Exposures: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Main Outcomes and Measures: Proportion of clinics accepting new patients and days to first appointment. Results: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. Conclusions and Relevance: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.