Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 93
Filter
1.
Eur Addict Res ; 28(1): 80-86, 2022.
Article in English | MEDLINE | ID: covidwho-1822119

ABSTRACT

INTRODUCTION: Opioid agonist treatment (OAT) is the first-line treatment for opioid dependence. Currently available OAT options comprise oral (methadone and morphine) and sublingual (buprenorphine) routes of administration. In Switzerland and some other countries, severely opioid-dependent individuals with insufficient response to oral or sublingual OAT are offered heroin-assisted treatment (HAT), which involves the provision of injected or oral medical heroin (diacetylmorphine [DAM]). However, many patients on treatment with injectable DAM (i-HAT) suffer from injection-related problems such as deteriorated vein status, ulcerations, endocarditis, and abscesses. Other patients who do not respond to oral OAT do not inject but snort opioids, and are not eligible for i-HAT. For this population, there is no other short-acting OAT with rapid onset of action available unless they switch to injecting, which is associated with higher risks. Nasal DAM (n-HAT) could be an alternative treatment option suitable for both populations of patients. METHODS: We present a case series of 3 patients on i-HAT who successfully switched to n-HAT. RESULTS/CONCLUSIONS: This is the first description of the clinical use of the nasal route of administration for HAT. n-HAT may constitute an important risk-reduced rapid-onset alternative to i-HAT. In particular, it may be suited for patients with injection-related complications, or noninjecting opioid-dependent patients failing to respond to oral OAT.


Subject(s)
Buprenorphine , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Heroin/therapeutic use , Humans , Methadone/therapeutic use , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy
2.
J Addict Med ; 16(2): 130-131, 2022.
Article in English | MEDLINE | ID: covidwho-1816281

ABSTRACT

State policies play a critical role in determining health care delivery, health equity, and health outcomes, but vary widely in scope, target, restrictiveness, and goals. Understanding how such policies impact health care is critical to development of evidence-based policies, but difficult in the absence of organized and standardized approaches to analysis. Development of themes and frameworks for analysis, and identification of policies supported by evidence, are important steps in moving toward more rational and aligned policies. Buprenorphine treatment for opioid use disorder provides a good example and methodological foundation. At the same time, state policies are promulgated within a larger policy, treatment, and socio-economic environment, and these influences must be considered as well.


Subject(s)
Addiction Medicine , Buprenorphine , Opioid-Related Disorders , Buprenorphine/therapeutic use , Delivery of Health Care , Health Policy , Humans , Opioid-Related Disorders/drug therapy
3.
J Am Board Fam Med ; 35(2): 215-218, 2022.
Article in English | MEDLINE | ID: covidwho-1775617

ABSTRACT

This issue continues our tradition of advancing family medicine by publishing articles on issues that affect patients and the practice of family medicine, specifically with an emphasis on inequity and the COVID pandemic, which are often intertwined. We have articles on topical issues such as appropriate transgender care, newer diabetes medications, transportation as a social risk, and a thought-provoking commentary on ableism. A clinical review on olfactory loss takes on new meaning. Oregon Medicaid coverage policy supported family physicians assisting their patients by decreasing their opioid use, and a article suggests that buprenorphine should be decriminalized. Strengthening the desire to enter family medicine before starting medical school can help meet future patient needs.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Buprenorphine/therapeutic use , COVID-19/epidemiology , Family Practice , Humans , Opioid-Related Disorders/drug therapy , Physicians, Family , United States/epidemiology
5.
Addict Sci Clin Pract ; 17(1): 16, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731544

ABSTRACT

BACKGROUND: Morbidity and mortality related to opioid use disorder (OUD) in the U.S. is at an all-time high. Innovative approaches are needed to address gaps in retention in treatment with medications for opioid use disorder (MOUD). Mobile health (mHealth) approaches have shown improvement in engagement in care and associated clinical outcomes for a variety of chronic diseases, but mHealth tools designed specifically to support patients treated with MOUD are limited. METHODS: Following user-centered development and testing phases, a multi-feature smartphone application called HOPE (Heal. Overcome. Persist. Endure) was piloted in a small cohort of patients receiving MOUD and at high risk of disengagement in care at an office-based opioid treatment (OBOT) clinic in Central Virginia. Outcomes were tracked over a six-month period following patient enrollment. They included retention in care at the OBOT clinic, usage of various features of the application, and self-rated measures of mental health, substance use, treatment and recovery. RESULTS: Of the 25 participants in the HOPE pilot study, a majority were retained in care at 6 months (56%). Uptake of bi-directional features including messaging with providers and daily check-ins of mood, stress and medication adherence peaked at one month, and usage persisted through the sixth month. Patients who reported that distance to clinic was a problem at baseline had higher loss to follow up compared to those without distance as a reported barrier (67% vs 23%, p = 0.03). Patients lost to in-person clinic follow up continued to engage with one or more app features, indicating that mHealth approaches may bridge barriers to clinic visit attendance. Participants surveyed at baseline and 6 months (N = 16) scored higher on scales related to overall self-control and self-efficacy related to drug abstinence. CONCLUSIONS: A pilot study of a novel multi-feature smartphone application to support OUD treatment showed acceptable retention in care and patient usage at 6 months. Further study within a larger population is needed to characterize 'real world' uptake and association with outcomes related to retention in care, relapse prevention, and opioid-associated mortality.


Subject(s)
Buprenorphine , COVID-19 , Mobile Applications , Opioid-Related Disorders , Buprenorphine/therapeutic use , Communicable Disease Control , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pilot Projects , SARS-CoV-2 , Smartphone
6.
Drug Alcohol Depend ; 231: 109241, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1719617

ABSTRACT

BACKGROUND: Rural, poor, persons with HIV (PWH) and substance use are among the most vulnerable to SARS-CoV-2 and related health service disruptions. The objective of the study was to evaluate the health outcomes and utilization of PWH at an Outpatient-based Opioid Treatment (OBOT) Clinic. METHODS: We evaluated a clinic-based cohort at the University of Alabama at Birmingham HIV clinic from November 2018 to May 2021. We compared HIV outcomes of OBOT patients, who are highly vulnerable, to the overall clinic. We stratified OBOT patients according to comorbid stimulant use disorder and compared clinic utilization and viral load suppression in the 6 months before and after the safer at home mandate (May 2020) in Alabama. RESULTS: Of 3857 PWH, 57 were referred to OBOT, 48 attended, 45 were initiated on buprenorphine, and 35 had a VL< 200 in the last 6 months. Relative to the overall HIV clinic, OBOT patients were significantly less likely to remain VL suppressed (90% vs 78%, p = 0.01). More patients were suppressed after OBOT linkage (81%) than prior (73%). For those referred before May 2020, there was no change in viral suppression before and after the safer at home order (75%). Although new OBOT referrals did not increase during the pandemic, the number of visits attended per month did increase from a median of 3-4 per patient. CONCLUSIONS: Unlike many PWH who faced access barriers, PWH receiving care at OBOT did not fall out of care but increased healthcare utilization and maintained viral suppression despite the public health emergency.


Subject(s)
Buprenorphine , COVID-19 , HIV Infections , Opioid-Related Disorders , Buprenorphine/therapeutic use , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Pandemics , SARS-CoV-2
7.
JAAPA ; 34(6): 1-4, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1684812

ABSTRACT

ABSTRACT: Preliminary data suggest that opioid-related overdose deaths have increased subsequent to COVID-19. Despite national support for expanding the role of physician assistants (PAs) and NPs in serving patients with opioid use disorder, these clinicians are held to complex and stringent regulatory barriers. COVID-19 triggered significant changes from regulatory and federal agencies, yet disparate policies and regulations persist between physicians and PAs and NPs. The dual epidemics of COVID-19 and opioid use disorder highlight the inadequate infrastructure required to support patients, communities, and clinicians, and may serve as the catalyst for eliminating barriers to care.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/legislation & jurisprudence , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Buprenorphine/therapeutic use , COVID-19/prevention & control , Drug Prescriptions , Health Policy/legislation & jurisprudence , Humans , Legislation, Drug , Narcotic Antagonists/therapeutic use , Nurse Practitioners/legislation & jurisprudence , Opioid Epidemic , Physician Assistants/legislation & jurisprudence , Physicians/legislation & jurisprudence , SARS-CoV-2 , Telemedicine , United States/epidemiology
8.
J Addict Med ; 16(1): e44-e47, 2022.
Article in English | MEDLINE | ID: covidwho-1672291

ABSTRACT

OBJECTIVES: Before the COVID-19 pandemic, many pregnant patients experienced barriers in accessing opioid use disorder (OUD) medication. This project surveyed buprenorphine treatment clinics to determine how many accepted pregnant women before and then during the pandemic. Of those clinics accepting pregnant patients during the pandemic, respondents were asked what services were provided and what forms of payment they accepted. METHODS: Between July and September 2020, phone contact was made with every sixth unduplicated clinic in North Carolina listed in the Substance Abuse and Mental Health Administration treatment locator (N = 490 clinics). The response rate was 53%. RESULTS: Of the 128 clinics responding, 62 clinics (48%) failed to treat pregnant patients both before and during the pandemic, whereas 66 clinics (52%) accepted pregnant patients before the COVID-19 pandemic, with only 44 (66%) of these clinics accepting pregnant patients during the pandemic. Thus, 33% fewer clinics accepted pregnant women for OUD treatment. Of these 44 clinics, 52% provided same-day intake, 45% prescribed naltrexone, and 57% offered detoxification with opioid agonists. Self-pay (95%), private insurance (77%), and Medicaid (55%) were accepted as payment. Clinics commonly reported providing individual counseling (86%). No clinics provided childcare or transportation. CONCLUSIONS: Almost half of the buprenorphine clinics in North Carolina turned away pregnant patients before the pandemic. During the pandemic, only 34% accepted pregnant patients, with 33% clinics that had provided medication treatment before the pandemic declining to treat pregnant patients for OUD. Thus, it is critical that policymakers ensure OUD treatment clinics accept pregnant patients.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Female , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Pregnancy , SARS-CoV-2 , United States
9.
J Addict Med ; 16(1): e59-e61, 2022.
Article in English | MEDLINE | ID: covidwho-1672294

ABSTRACT

Criminal justice involved individuals have a high rate of opioid overdose death following release. In March 2020, New York City jails released over 1000 inmates due to concern of COVID-19 outbreaks in county jails. The closure of addiction treatment clinics further complicated efforts to expand access to medications for opioid use disorder among criminal justice involved adults. The New York City Health + Hospitals Virtual Buprenorphine Clinic established in March 2020 offered low-threshold telemedicine-based opioid treatment with buprenorphine-naloxone, specifically for criminal justice involved adults post-release. We describe a case report of the novel role of tele-conferencing for the provision of buprenorphine-naloxone for jail-released adults with opioid use disorder experiencing homelessness during the COVID-19 pandemic. The patient is a 49-year-old male with severe opioid use disorder released from New York City jail as part of its early release program. He then started using diverted buprenorphine-naloxone, and 1 month later a harm-reduction specialist at his temporary housing at a hotel referred him to an affiliated buprenorphine provider and then eventually to the New York City Health + Hospitals Virtual Buprenorphine Clinic, where he was continued on buprenorphine-naloxone, and was followed biweekly thereafter until being referred to an office-based opioid treatment program. For this patient, telemedicine-based opioid treatment offered a safe and feasible approach to accessing medication for opioid use disorder during the COVID-19 pandemic and following incarceration.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Telemedicine , Adult , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Criminal Law , Humans , Male , Middle Aged , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2
10.
Addict Sci Clin Pract ; 17(1): 6, 2022 01 31.
Article in English | MEDLINE | ID: covidwho-1662427

ABSTRACT

BACKGROUND: To address the US opioid epidemic, there is an urgent clinical need to provide persons with opioid use disorder (OUD) with effective medication treatments for OUD (MOUD). Formulations of sublingual buprenorphine/naloxone (SL-BUP/NLX) are considered the standard of care for OUD including within the Veterans Healthcare Administration (VHA). However, poor retention on MOUD undermines its effectiveness. Long-acting injectable monthly buprenorphine (INJ-BUP) (e.g., Sublocade®) has the potential to improve retention and therefore reduce opioid use and overdose. Designing and conducting studies for OUD pose unique challenges. The strategies and solutions to some of these considerations in designing Cooperative Studies Program (CSP) 2014, Buprenorphine for Treating Opioid Use Disorder in Veterans (VA-BRAVE), a randomized, 20-site, clinical effectiveness trial comparing INJ-BUP to SL-BUP/NLX conducted within the VHA may provide valuable guidance for others confronted with similar investigation challenges. METHODS: This 52-week, parallel group, open-label, randomized controlled trial (RCT) evaluates the comparative effectiveness of two current FDA-approved formulations of buprenorphine: (1) daily SL-BUP/NLX vs. (2) monthly (28-day) INJ-BUP for Veterans with moderate to severe OUD (n = 952). The primary outcomes are (1) retention in MOUD and (2) opioid abstinence. Secondary outcomes include measures of other drug use, psychiatric symptoms, medical outcomes including prevalence rates of HIV, hepatitis B and C as well as social outcomes (housing instability, criminal justice involvement), service utilization and cost-effectiveness. Special considerations in conducting a comparative effectiveness trial with this population and during COVID-19 pandemic were also included. DISCUSSION: The evaluation of the extended-release formulation of buprenorphine compared to the standard sublingual formulation in real-world VHA settings is of paramount importance in addressing the opioid epidemic. The extent to which this new treatment facilitates retention, decreases opioid use, and prevents severe sequelae of OUD has not been studied in any long-term trial to date. Positive findings in this trial could lead to widespread adoption of MOUD, and, if proven superior INJ-BUP, by clinicians throughout the VHA and beyond. This treatment has the potential to reduce opioid use among Veterans, improve medical, psychological, and social outcomes, and save lives at justifiable cost. Trial registration Registered at Clinicaltrials.gov NCT04375033.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Veterans , Buprenorphine/therapeutic use , Humans , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , SARS-CoV-2
11.
Drug Alcohol Depend ; 232: 109291, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1616457

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, federal agencies relaxed buprenorphine prescribing restrictions including for incarcerated individuals. The impact of COVID-19 on the supply of MOUD in U.S. prisons and jails is not known. METHODS: We used cross-sectional national monthly data from the IQVIA National Sales Perspective (NSP) for the total volume of medicines supplied to city, county and state prisons and jails and other types of institutional facilities in the U.S. We measured the total monthly supply (or volume) as extended units (EUs) for MOUDs overall and by type. We used interrupted time series analysis to evaluate changes in monthly volume of MOUDs in prisons and jails and other types of facilities (hospitals, clinics and long-term care) before (January 2018-February 2020) and during the COVID-19 (March 2020-October 2020) pandemic. RESULTS: The availability of MOUD in jails and prisons increased by 471.3% between January 2018 (52,784 EU) and October 2020 (333,226 EU). This increase was largely driven by increased volume of buprenorphine/naloxone and was not observed in other institutional facilities, including hospitals, clinics and long-term care, and. Specifically, the mean monthly volume of buprenorphine/naloxone at prisons/jails increased every month before the pandemic by 1860 EU (95% CI, 1110-2360). In March 2020, the mean volume of buprenorphine/naloxone increased by 81,930 EU (95% CI, 59,040-104,820) per month, followed by a significant increase of 24,010 EU (95% CI 19,530-28,490) per month during the pandemic vs before the pandemic. CONCLUSION: These findings may indicate increased availability of buprenorphine/naloxone, a safe and effective MOUD, in prisons and jails since the start of the COVID-19 pandemic in the U.S. despite previous barriers in its use.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Cross-Sectional Studies , Humans , Jails , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Prisons , SARS-CoV-2 , United States/epidemiology
14.
J Subst Abuse Treat ; 136: 108687, 2022 05.
Article in English | MEDLINE | ID: covidwho-1568877

ABSTRACT

INTRODUCTION: This study evaluates if social distancing measures instituted during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic were associated with a reduction in Medication for Opioid Use Disorder (MOUD) prescribing in West Virginia. The COVID-19 pandemic necessitated the quick implementation of public health interventions such as social distancing. This led to the use of telemedicine in the clinical setting however implementing telemedicine involves system level and infrastructure level changes within a healthcare environment. This could cause a barrier to MOUD delivery as it is often provided concomitantly with other face to face substance use and mental health services. The purpose of this study is to determine whether social distancing was associated with a reduction in MOUD prescribing in West Virginia, with the goal of adding to the knowledge of how COVID-19 and COVID-19-related mitigation strategies have impacted patients with OUD. METHODS: Prescription monitoring data were requested from the West Virginia Board of Pharmacy. We applied interrupted time series modeling to investigate MOUD prescribing practices before and after social distancing took effect. Gabapentin prescriptions were utilized as a control for comparison. RESULTS: Our study assessed state-wide buprenorphine and Suboxone prescriptions as compared to a control medication and found an increase in dosage of both medications and an increase in number of buprenorphine prescriptions, but a small decrease in buprenorphine/naloxone prescription number related to the dates of implementation of social distancing. Taken together, overall this indicates an increase in prescription number of MOUD prescriptions as well as an increase in dosage. CONCLUSION: This study suggests that social distancing measures were associated with an increase in both the number of MOUD prescriptions and the number of doses in each prescription. Significant alterations to MOUD delivery in the clinical setting were implemented in a short timeframe with the COVID-19 pandemic. Understanding the implementation of clinical measures to accommodate social distancing measures may provide benefit to transformation of future delivery of MOUD.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Buprenorphine/therapeutic use , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Physical Distancing , SARS-CoV-2 , West Virginia
16.
J Subst Abuse Treat ; 132: 108621, 2022 01.
Article in English | MEDLINE | ID: covidwho-1553723

ABSTRACT

INTRODUCTION: Despite the impact of the opioid overdose crisis on the United States, few physicians are trained to provide treatment with buprenorphine. While research has described some factors contributing to comfort in providing buprenorphine treatment, more research is needed to identify optimal strategies to produce physicians who prescribe this medication. METHODS: A community-based family medicine residency in Massachusetts sought to improve residents' comfort with prescribing buprenorphine by integrating patients treated with buprenorphine directly into resident continuity clinic panels in addition to existing mandatory didactic teaching. RESULTS: The program saw a significant increase in buprenorphine prescribing among residency graduates three years after graduation after integration of patients on buprenorphine into resident continuity panels. CONCLUSION: Efforts to further increase the number of graduates prescribing buprenorphine nationwide should emphasize supervised management of patients treated with buprenorphine during residency.


Subject(s)
Buprenorphine , Drug Overdose , Internship and Residency , Opioid-Related Disorders , Physicians , Buprenorphine/therapeutic use , Drug Overdose/drug therapy , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Practice Patterns, Physicians' , United States
17.
J Subst Abuse Treat ; 135: 108641, 2022 04.
Article in English | MEDLINE | ID: covidwho-1549951

ABSTRACT

INTRODUCTION: In 2020, the US and New York City experienced unprecedented deaths due to the COVID-19 pandemic and drug overdoses. Policy changes reduced burdensome regulations for medication treatment for opioid use disorder (OUD). Despite these policy changes, few studies examined buprenorphine treatment outcomes during the pandemic. We compared treatment outcomes among Bronx patients referred to office-based buprenorphine treatment before versus during the pandemic. METHODS: In a retrospective cohort study, we compared patients referred to buprenorphine treatment in a Bronx community clinic before (March-August 2019) versus during (March-August 2020) the pandemic. We describe changes to buprenorphine treatment during the pandemic, including telehealth and prioritizing harm reduction. Using data from medical records and program logs, main outcomes included steps of the OUD treatment cascade of care-initial visit scheduled and completed, treatment initiated, and retained in treatment at 90 days. Using chi square and t-tests, we examined differences in patient characteristics and OUD treatment cascade steps before versus during the pandemic. RESULTS: Before and during the pandemic, 72 and 35 patients were referred to buprenorphine treatment, respectively. Patients' mean age was 46 years, most were male (67.3%) or Hispanic (52.3%), and few had private insurance (19.6%). Patients referred during (vs. before) the pandemic were more likely to have private insurance (31.4% vs. 13.9%, p < 0.05) and be referred from acute care settings (37.1% vs. 19.4%, p < 0.05). No significant differences in OUD cascade of care outcomes existed between those referred during versus before the pandemic. However, among patients who initiated buprenorphine treatment, those referred during (vs. before) the pandemic were more likely to be retained in treatment at 90 days (68.0% vs. 42.9%, p < 0.05). CONCLUSIONS: Despite the COVID-19 pandemic's unprecedented devastation to the Bronx, along with worsening drug overdose deaths, OUD cascade of care outcomes were similar among patients referred to buprenorphine treatment before versus during the pandemic. Among patients who initiated buprenorphine treatment, treatment retention was better during (versus before) the pandemic. During a public health emergency, incorporating telehealth and prioritizing harm reduction are key strategies to maintain optimal OUD treatment outcomes.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Buprenorphine/therapeutic use , Humans , Male , Middle Aged , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
19.
Harm Reduct J ; 18(1): 119, 2021 11 25.
Article in English | MEDLINE | ID: covidwho-1538076

ABSTRACT

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.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Telemedicine , Buprenorphine/therapeutic use , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2 , United States
20.
Drug Alcohol Depend ; 230: 109187, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1536511

ABSTRACT

BACKGROUND: Changes in federal policy during the COVID-19 pandemic allowing for the use of telemedicine to treat opioid use disorder (OUD) have facilitated innovative strategies to engage and retain people in treatment. Since 2018, the Baltimore City Health Department has operated a mobile street medicine program called Healthcare on The Spot (The Spot) that provides treatment for OUD and infectious diseases. This study describes the transition of The Spot's buprenorphine service to telemedicine during the COVID-19 pandemic and one year treatment retention. METHODS: Patients actively engaged in care at the time of transition to telemedicine and patients newly engaged in buprenorphine services through telemedicine were included in this descriptive analysis and assessed at one year for retention. RESULTS: From March 16, 2020 to March 15, 2021, The Spot provided voice-only buprenorphine treatment services to 150 patients, 70.7% (n = 106) male and 80.0% (n = 120) Black; 131 were patients who transitioned from in person services and 19 were newly engaged via telemedicine. 80.7% (n = 121) of patients remained engaged in treatment at one year, 16.0% (n = 24) were lost to follow-up, and 3.3% (n = 5) were deceased. Patients newly engaged via telemedicine were more likely to be female and white than those retained from in person services. CONCLUSION: The Spot's transition of patients from a street medicine program to telemedicine during the COVID-19 pandemic has implications for future practice. Increased flexibility of service delivery, extended prescription length, and decreased UDT likely contributed to high retention rates and should inform the future structure of low-threshold buprenorphine programs.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Telemedicine , Buprenorphine/therapeutic use , Female , Humans , Male , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL