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2.
Subst Abus ; 43(1): 1143-1150, 2022.
Article in English | MEDLINE | ID: covidwho-1830535

ABSTRACT

Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51 years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.


Subject(s)
COVID-19 , Drug Overdose , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Drug Overdose/drug therapy , Female , Freedom , Humans , Male , Methadone/therapeutic use , Middle Aged , Opioid-Related Disorders/epidemiology , Pandemics , Qualitative Research , United States
3.
JAMA Netw Open ; 5(4): e227028, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1798069

ABSTRACT

Importance: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. Objective: To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. Design, Setting, and Participants: This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. Exposures: Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). Main Outcomes and Measures: Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). Results: Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). Conclusions and Relevance: In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , COVID-19/drug therapy , Cross-Sectional Studies , Health Services Accessibility , Humans , Methadone/therapeutic use , Naltrexone/therapeutic use , Opiate Substitution Treatment/methods , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , United States/epidemiology
4.
Front Public Health ; 10: 811001, 2022.
Article in English | MEDLINE | ID: covidwho-1776008

ABSTRACT

Background: Opioid overdose related injury or death can be prevented by bystander naloxone administration. For naloxone to be present when and where overdoses occur, opioid prevention education and naloxone distribution (OPEND) must be established on a broad level. This is the 30-month follow-up of the first multi-site naloxone project in Sweden, implemented at 31 sites in the County of Skåne 2018. Aim: To address participant characteristics and factors associated with returning for naloxone refill and with having used naloxone for overdose reversal. An additional aim was to describe self-reported reasons for naloxone refill and overdose experiences. Methods: Data were collected during June 2018-December 2020 through questionnaires at baseline and upon naloxone refill of the initial and subsequent naloxone kit. Descriptive statistics was used to address participant characteristics, those returning for naloxone refill and reporting overdose reversal. Chi-2 test was used for variable comparison between groups. Factors associated with overdose reversals were examined by logistic regression analysis. Reasons for naloxone refill, overdose situation and management were presented descriptively. Results: Among 1,079 study participants, 22% (n = 235) returned for naloxone refill, of which 60% (n = 140) reported a total of 229 overdose reversals. Reversals were more likely to be reported by participants trained at needle exchange programs (NEPs) [adjusted odds ratio (AOR) = 5.18, 95% Confidence interval (CI) = 3.38-7.95)], with previous experience of own (AOR = 1.63, 95% CI = 1.03-2.58) or witnessed (AOR = 2.12, 95% CI = 1.05-4.29) overdose, or who had used sedatives during the last 30 days before initial training (AOR = 1.56, 95% CI = 1.04-2.33). A majority of overdoses reportedly occurred in private settings (62%), where the victim was a friend (35%) or acquaintance (31%) of the rescuer. Conclusion: Participants with own risk factors associated with overdose (e.g., injection use, concomitant use of benzodiazepines and previous experience of own overdose) were more likely to report administering naloxone for overdose reversal. Overdose management knowledge was high. The findings indicate that implementation of multi-site OPEND reaches individuals at particularly high risk of own overdose in settings with limited previous harm reduction strategies and favors a further scaling up of naloxone programs in similar settings.


Subject(s)
Naloxone , Narcotic Antagonists , Opioid-Related Disorders , Humans , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Sweden/epidemiology
5.
BMC Health Serv Res ; 22(1): 418, 2022 Mar 30.
Article in English | MEDLINE | ID: covidwho-1770536

ABSTRACT

BACKGROUND: Opioid treatment programs (OTPs) serve as daily essential services for people with opioid use disorder. This study seeks to identify modifications to operations and adoption of safety measures at Pennsylvania OTPs during the COVID-19 pandemic. METHODS: A 25-min online survey to clinical and administrative directors at all 103 state-licensed OTPs in Pennsylvania was fielded from September to November 2020. Survey domains included: 1) changes to services, client volume, hours and staffing during the COVID-19 pandemic 2) types of services modifications 3) safety protocols to reduce COVID-19 transmission 4) challenges to operations during the pandemic. RESULTS: Forty-seven directors responded, for a response rate of 45%. Almost all respondents reported making some service modification (96%, n = 43). Almost half (47%, n = 21) of respondents reported reductions in the number of clients served. OTPs were more likely to adopt safety protocols that did not require significant funding, such as limiting the number of people entering the site (100%, n = 44), posting COVID-safety information (100%, n = 44), enforcing social distancing (98%, n = 43), and increasing sanitation (100%, n = 44). Only 34% (n = 14) of OTPS provided N95 masks to most or all staff. Respondents reported that staff's stress and negative mental health (86%, n = 38) and staff caregiving responsibilities (84%, n = 37) during the pandemic were challenges to maintaining OTP operations. CONCLUSION: OTPs faced numerous challenges to operations and adoption of safety measures during the COVID-19 pandemic. Funding mechanisms and interventions to improve adoption of safety protocols, staff mental health as well as research on patient experiences and preferences can inform further OTP adaptation to the COVID-19 pandemic and future emergency planning.


Subject(s)
COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/prevention & control , Pandemics/prevention & control , Surveys and Questionnaires
8.
Am J Emerg Med ; 54: 221-227, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1748324

ABSTRACT

OBJECTIVES: Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED). Our secondary aim was to determine if Black and Hispanic patients were more likely to have >3 referrals. METHODS: This retrospective cohort study was conducted at a large urban safety-net hospital and included patients seen in the ED from July 2018 to September 2019 with ICD-10 codes for an opioid-related visit and who sought placement to inpatient detox. A generalized linear mixed model controlling for multiple visits, age, sex, insurance, time, day of week, and time of year was used to assess the association between race/ethnicity and hypothesized barriers to placement. The proportion of patients with >3 visits for referral to inpatient detox was compared between Black and Hispanic patients and white patients using a chi-squared test. RESULTS: We identified 1733 encounters from 782 unique patients seeking connection to inpatient detox for OUD. Of the 1733 encounters, 45% were among Black and Hispanic patients. Hispanic and Black men had significantly lower odds of having a barrier to inpatient OUD detox than white men (OR = 0.734, 95% CI 0.542-0.995). No significant difference was found for Hispanic and Black women (OR = 1.212, 95% CI 0.705-2.082). More Black and Hispanic patients experienced >3 referrals to inpatient detox compared to white patients (19.2% vs 12.9%, p = 0.016). CONCLUSIONS: This study suggests in the context of near-universal health insurance coverage, an ED-based OUD support program staffed by diverse community members can mitigate inequities in access to inpatient detox. However, the increased number of ED visits for OUD detox placement by Black and Hispanic patients suggests racial inequities in OUD treatment exist after linkage to care. Additional research should explore the causes, specifically structural and interpersonal racism, and determine solutions to address racial inequities in detox placement as well as maintenance in treatment programs.


Subject(s)
Emergency Medical Services , Opioid-Related Disorders , Female , Humans , Inpatients , Male , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Retrospective Studies , United States
9.
Subst Abuse Treat Prev Policy ; 17(1): 22, 2022 03 18.
Article in English | MEDLINE | ID: covidwho-1745438

ABSTRACT

BACKGROUND: The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS: The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS: The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS: The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.


Subject(s)
COVID-19 , Opioid-Related Disorders , Humans , Male , Opioid-Related Disorders/epidemiology , Pandemics , Public Health , Qualitative Research
10.
Clin Cardiol ; 45(5): 536-539, 2022 May.
Article in English | MEDLINE | ID: covidwho-1733857

ABSTRACT

BACKGROUND AND OBJECTIVES: Compare proportion of all-cause and cause-specific mortality among West Virginia Medicaid enrollees who were discharged from infective endocarditis (IE) hospitalization with and without opioid use disorder (OUD) diagnosis. METHODS: The proportions of cause-specific deaths among those who were discharged from IE-related hospitalizations were compared by OUD diagnosis. RESULTS: The top three underlying causes of death discharged from IE hospitalization were accidental drug poisoning, mental and behavioral disorders due to polysubstance use, and cardiovascular diseases. Of the total deaths occurring among patients discharged after IE-related hospitalization, the proportion has increased seven times from 2016 to 2019 among the OUD deaths while it doubled among the non-OUD deaths. DISCUSSION AND CONCLUSIONS: Of the total deaths occurring among patients discharged after IE-related hospitalization, the increase is higher in those with OUD diagnosis. OUD is becoming a significantly negative impactor on the survival outcome among IE patients. It is of growing importance to deliver medication for OUD treatment and harm reduction efforts to IE patients in a timely manner, especially as the COVID-19 pandemic persists.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Opioid-Related Disorders , Cause of Death , Endocarditis/diagnosis , Hospitalization , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Patient Discharge , Retrospective Studies , United States , West Virginia/epidemiology
11.
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
12.
Subst Abuse Treat Prev Policy ; 17(1): 16, 2022 03 05.
Article in English | MEDLINE | ID: covidwho-1724512

ABSTRACT

BACKGROUND: Timely data from official sources regarding the impact of the COVID-19 pandemic on people who use prescription and illegal opioids is lacking. We conducted a large-scale, natural language processing (NLP) analysis of conversations on opioid-related drug forums to better understand concerns among people who use opioids. METHODS: In this retrospective observational study, we analyzed posts from 14 opioid-related forums on the social network Reddit. We applied NLP to identify frequently mentioned substances and phrases, and grouped the phrases manually based on their contents into three broad key themes: (i) prescription and/or illegal opioid use; (ii) substance use disorder treatment access and care; and (iii) withdrawal. Phrases that were unmappable to any particular theme were discarded. We computed the frequencies of substance and theme mentions, and quantified their volumes over time. We compared changes in post volumes by key themes and substances between pre-COVID-19 (1/1/2019-2/29/2020) and COVID-19 (3/1/2020-11/30/2020) periods. RESULTS: Seventy-seven thousand six hundred fifty-two and 119,168 posts were collected for the pre-COVID-19 and COVID-19 periods, respectively. By theme, posts about treatment and access to care increased by 300%, from 0.631 to 2.526 per 1000 posts between the pre-COVID-19 and COVID-19 periods. Conversations about withdrawal increased by 812% between the same periods (0.026 to 0.235 per 1,000 posts). Posts about drug use did not increase (0.219 to 0.218 per 1,000 posts). By substance, among medications for opioid use disorder, methadone had the largest increase in conversations (20.751 to 56.313 per 1,000 posts; 171.4% increase). Among other medications, posts about diphenhydramine exhibited the largest increase (0.341 to 0.927 per 1,000 posts; 171.8% increase). CONCLUSIONS: Conversations on opioid-related forums among people who use opioids revealed increased concerns about treatment and access to care along with withdrawal following the emergence of COVID-19. Greater attention to social media data may help inform timely responses to the needs of people who use opioids during COVID-19.


Subject(s)
COVID-19 , Opioid-Related Disorders , Social Media , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Humans , Natural Language Processing , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2
13.
Int J Drug Policy ; 103: 103644, 2022 May.
Article in English | MEDLINE | ID: covidwho-1712564

ABSTRACT

BACKGROUND: In March 2020, the Ontario government declared a state of emergency due to the growing risk of COVID-19. In response, new guidance for the management of opioid agonist therapy (OAT) was released, which included the expansion of eligibility for take-home doses. We investigated the impact of these changes on trends in the distribution of take-home doses of OAT. METHODS: We conducted a population-based time series analysis among residents of Ontario, Canada who were dispensed OAT between June 25, 2019 and November 30, 2020. For each week of the study period, we calculated the percentage of people dispensed (a) methadone and (b) buprenorphine/naloxone by the number of take-home doses received. We used interventional autoregressive integrated moving average models to estimate changes in the percentage of people dispensed each category of take-home doses in the weeks following the declaration of the state of emergency and release of the OAT dispensing guidance. RESULTS: Following the state of emergency and release of the OAT dispensing guidance, there was a significant increase in the percentage of Ontarians dispensed 7 to 13 (3.6% increase; p = 0.033) and 14 or more (0.8% increase; p<0.001) take-home doses of methadone, and in the percentage of people dispensed 7 to 13 (4.3% increase; p = 0.001), 14 to 27 (2.8% increase; p<0.001), and 28 or more (0.3% increase; p = 0.008) take-home doses of buprenorphine/naloxone. There were significant decreases in the percentage of Ontarians receiving daily dispensed buprenorphine/naloxone (-3.1%; p = 0.001), as well as the percentage dispensed 1 to 6 take-home doses of methadone (-4.5%; p = 0.001) and buprenorphine/naloxone (-4.9%; p = 0.001). CONCLUSION: The new guidance for dispensing OAT in Ontario resulted in increases in the duration of take-home doses of methadone and buprenorphine/naloxone supplied. However, given that changes were small, strategies to improve retention in OAT and ensure equitable access to take-home dosing should continue.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Analgesics, Opioid , Buprenorphine/therapeutic use , Buprenorphine, Naloxone Drug Combination/therapeutic use , Humans , Methadone , Ontario/epidemiology , Opiate Substitution Treatment/methods , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics
14.
J Womens Health (Larchmt) ; 31(5): 640-647, 2022 05.
Article in English | MEDLINE | ID: covidwho-1692279

ABSTRACT

Objectives: (1) Report sex-specific prevalence of coronavirus disease 2019 (COVID-19) test positivity among an opioid use disorder (OUD) cohort (2) Assess sex-specific rates of opioid overdose and mortality. Methods: A retrospective cohort study was performed on all adult patients with OUD who received a COVID-19 test in calendar year 2020 at a large academic medical center in Richmond, Virginia. Our study outcomes were positive COVID-19 test, opioid overdose, and all-cause in-hospital mortality. Sex-stratified multivariable logistic regression assessed sociodemographic factors associated with COVID-19 test positivity. Results: A total of 2,600 patients (males = 1,294, females = 1,306) with OUD received a COVID-19 test. Approximately 5% across both sexes tested positive for COVID-19 (p = 0.420), whereas 7% presented with an opioid overdose (males 10%; females 4%; p < 0.0001). However, mortality rates were similar across sex. Among males, individuals in the other racial group had increased odds of COVID-19 test positivity (adjusted odds ratio or AOR: 5.03, 95% confidence interval [CI]: 1.70-14.88), whereas black females had higher odds of COVID-19 test positivity (AOR: 1.92, 95% CI: 1.01-3.62) compared to their white counterparts. Conclusions: Opioid overdose, more often than COVID-19, impacted the health of patients with OUD presenting to a public safety net health system. Despite a female advantage documented in the general population for COVID-19 susceptibility, COVID-19 test positivity rates were similar across sex in an OUD cohort; yet, racial disparities emerged with notable sex-related variation. Sex and gender are important variables that modify health outcomes, including OUD and COVID-19, and should be further investigated using an intersectionality framework.


Subject(s)
COVID-19 , Opiate Overdose , Opioid-Related Disorders , Adult , Analgesics, Opioid/therapeutic use , Female , Humans , Male , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Retrospective Studies
15.
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
16.
Drug Alcohol Depend ; 232: 109303, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1683062

ABSTRACT

INTRODUCTION: During the COVID-19 pandemic, patients with opioid use disorder (OUD) struggled with access to prescribers and opioid agonist therapy (OAT). Recognizing this gap in care, Health Canada issued a short-term subsection 56(1) class exemption from the Controlled Drugs and Substances Act authorizing pharmacists to independently manage controlled substances. The purpose of this study was to explore the expanded role of Canadian pharmacists in providing care to patients with OUD during the pandemic. METHODS: We conducted qualitative key informant telephone interviews in the fall of 2020 with Canadian pharmacists who used the exemption. We included community or primary healthcare team-based pharmacists who managed opioid medication under the exemption. We recorded, transcribed verbatim, and de-identified all transcripts. Data was analyzed using a thematic approach involving line-by-line coding and constant comparison. RESULTS: We interviewed nineteen pharmacists with representation from all provinces and urban and rural practice settings. Three major themes emerged that captured the pharmacists' perspectives when providing care for patients with OUD during the pandemic: (i) continuity of care; (ii) harm reduction; and (iii) access to care. Pharmacists used the exemption to extend prescriptions, transfer prescriptions, receive verbal orders, and deliver OAT. CONCLUSIONS: Throughout the pandemic, pharmacists were able to provide continuity of care to patients with OUD who would have otherwise been unable to access care. The exemption permitted pharmacists to assess patients and provide OAT through this expanded role. Other countries should look to the Canadian experience and leverage the expertise of the pharmacist to expand their scope so that they can help fill the gap in care for patients with OUD.


Subject(s)
COVID-19 , Opioid-Related Disorders , Canada , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Pharmacists , SARS-CoV-2
17.
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
18.
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
19.
JAAPA ; 35(2): 57-59, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1649920

ABSTRACT

ABSTRACT: The opioid epidemic has been the most significant public health crisis in the United States during the past 30 years. In 2021, it was second only to COVID-19. What happens when two epidemics collide and what should policy makers do about it? This article analyzes the burden of COVID-19 on patients with opioid addiction and discusses the beneficial policy changes that improve access to substance abuse care.


Subject(s)
COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2 , United States/epidemiology
20.
Stud Health Technol Inform ; 289: 123-127, 2022 Jan 14.
Article in English | MEDLINE | ID: covidwho-1643436

ABSTRACT

The goal of this paper is to apply unsupervised machine learning techniques in order to discover latent clusters in patients who have opioid misuse and also undergone COVID-19 testing. Target dataset has been constructed based on COVID-19 testing results at Mount Sinai Health System and opioid treatment program (OTP) information from New York State Office of Addiction Service and Support (OASAS). The dataset was preprocessed using factor analysis for mixed data (FAMD) method and then K-means algorithm along with elbow method were used to determine the number of optimal clusters. Four patient clusters were identified among which the fourth cluster constituted the maximum percentage of positive COVID-19 test results (20%). Compared to the other clusters, this cluster has the highest percentage of African Americans. This cluster has also the highest mortality rate (16.52%), hospitalization rate after receiving the COVID-19 test result (72.17%, use of ventilator (7.83%) and ICU admission rate (47.83%). In addition, this cluster has the highest percentage of patients with at least one chronic disease (99.13%) and age-adjusted comorbidity score more than 1 (83.48%). Longer participation in OTP was associated with the highest morbidity and mortality from COVID-19.


Subject(s)
COVID-19 , Opioid-Related Disorders , COVID-19 Testing , Humans , Opioid-Related Disorders/epidemiology , SARS-CoV-2 , Unsupervised Machine Learning
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