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2.
Rural Remote Health ; 21(4): 6770, 2021 11.
Article in English | MEDLINE | ID: covidwho-1513371

ABSTRACT

CONTEXT: The COVID-19 pandemic led to several changes to methadone treatment protocols at federal opioid treatment programs in the USA. ISSUE: Protocol changes were designed to reduce transmission of COVID-19 while allowing for continuity of care, but those changes also demonstrated that many policies surrounding opioid use disorder care in the USA cause unnecessary burdens to patients. In this commentary, we describe how current policies create and maintain fatal barriers to methadone treatment for people in rural communities who have opioid use disorder, and highlight how COVID-19 adaptations and more flexible methadone models in other countries can better allow for effective and accessible care. Reasons and ways to address these issues to create lasting solutions for rural communities are discussed. LESSONS LEARNED: We focus on three lessons: (1) methadone dispensing and take-home schedules during COVID-19, (2) telehealth services during COVID-19, and (3) international models in use prior to COVID-19. We then outline recommendations for each lesson to improve access to methadone treatment long term for rural communities in the USA. There is an urgent need to implement recommendations that maintain flexible approaches and address methadone treatment barriers in the rural USA. To achieve lasting health policy change and combat stigma about addiction and methadone treatment, there is a need for advocacy efforts that give voice to rural residents impacted by inequitable access to methadone treatment and rural-tailored educational initiatives that promote the evidence base for methadone. We hope opioid treatment program directors, regulatory authorities, and health policymakers consider our recommendations.


Subject(s)
COVID-19/psychology , Delivery of Health Care/organization & administration , Health Services Accessibility , Methadone/therapeutic use , Opiate Substitution Treatment/statistics & numerical data , Opioid-Related Disorders/rehabilitation , Rural Population , COVID-19/epidemiology , Humans , Opiate Substitution Treatment/methods , Opioid-Related Disorders/psychology , Pandemics , SARS-CoV-2 , United States
4.
J Subst Abuse Treat ; 123: 108276, 2021 04.
Article in English | MEDLINE | ID: covidwho-1139560

ABSTRACT

PURPOSE: Methadone maintenance treatment is a life-saving treatment for people with opioid use disorders (OUD). The coronavirus pandemic (COVID-19) has introduced many concerns surrounding access to opioid treatment. In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance allowing for the expansion of take-home methadone doses. We sought to describe changes to treatment experiences from the perspective of persons receiving methadone at outpatient treatment facilities for OUD. METHODS: We conducted an in-person survey among 104 persons receiving methadone from three clinics in central North Carolina in June and July 2020. Surveys collected information on demographic characteristics, methadone treatment history, and experiences with take-home methadone doses in the context of COVID-19 (i.e., before and since March 2020). RESULTS: Before COVID-19, the clinic-level percent of participants receiving any amount of days' supply of take-home doses at each clinic ranged from 56% to 82%, while it ranged from 78% to 100% since COVID-19. The clinic-level percent of participants receiving a take-homes days' supply of a week or longer (i.e., ≥6 days) since COVID-19 ranged from 11% to 56%. Among 87 participants who received take-homes since COVID-19, only four reported selling their take-home doses. CONCLUSIONS: Our study found variation in experiences of take-home dosing by clinic and little diversion of take-home doses. While SAMSHA guidance should allow expanded access to take-home doses, adoption of these guidelines may vary at the clinic level. The adoption of these policies should be explored further, particularly in the context of benefits to patients seeking OUD treatment.


Subject(s)
COVID-19 , Methadone/therapeutic use , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , Patient Satisfaction , SARS-CoV-2 , Adolescent , Adult , Drug Dosage Calculations , Female , Humans , Male , Methadone/administration & dosage , North Carolina , Surveys and Questionnaires , Young Adult
5.
Addict Sci Clin Pract ; 16(1): 13, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1102352

ABSTRACT

BACKGROUND: We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul's Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. EXPERIENCES: ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. RECOMMENDATIONS FOR THE FUTURE: We believe that ACS were essential to hospitals' readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/trends , Patient Admission/trends , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation , Telemedicine/trends , British Columbia , Buprenorphine/therapeutic use , Connecticut , Cross-Cultural Comparison , Forecasting , Health Plan Implementation/trends , Health Services Accessibility/trends , Humans , Massachusetts , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/rehabilitation , Oregon , Patient Care Team/trends , Patient Discharge/trends , Remote Consultation/trends
6.
Harm Reduct J ; 18(1): 20, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088598

ABSTRACT

The COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group-people who consume drugs. Several services across Europe and North America closed due to difficulties complying with physical distancing requirements. In contrast, the two supervised injecting facilities in Australia (the Uniting Medically Supervised Injecting Centre-MSIC-in Sydney and the North Richmond Community Health Medically Supervised Injecting Room-MSIR-in Melbourne) remained open (as at the time of writing-December 2020). Both services have implemented a comprehensive range of strategies to continue providing safer injecting spaces as well as communicating crucial health information and facilitating access to ancillary services (such as accommodation) and drug treatment for their clients. This paper documents these strategies and the challenges both services are facing during the pandemic. Remaining open poses potential risks relating to COVID-19 transmission for both staff and clients. However, given the harms associated with closing these services, which include the potential loss of life from injecting in unsafe/unsupervised environments, the public and individual health benefits of remaining open are greater. Both services are deemed 'essential health services', and their continued operation has important benefits for people who inject drugs in Sydney and Melbourne.


Subject(s)
COVID-19/prevention & control , Harm Reduction , Infection Control/methods , Needle-Exchange Programs , Opioid-Related Disorders/rehabilitation , Personal Protective Equipment , Physical Distancing , Substance Abuse, Intravenous/rehabilitation , Australia , COVID-19 Testing , Delivery of Health Care , Drug Overdose/therapy , Housing , Humans , Masks , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , New South Wales , Opiate Overdose/therapy , Opiate Substitution Treatment , Referral and Consultation , Resuscitation/methods , SARS-CoV-2 , Substance-Related Disorders , Victoria
7.
J Subst Abuse Treat ; 124: 108272, 2021 05.
Article in English | MEDLINE | ID: covidwho-1065390

ABSTRACT

Federal regulatory changes during the COVID-19 pandemic allow buprenorphine to be prescribed without an initial in-person evaluation. Prior to COVID-19, numerous barriers limited broad uptake of buprenorphine among people who use drugs at the system, provider, and patient levels, including lack of available DATA 2000 waivered clinicians to prescribe, stigma, and competing livelihood priorities. As two harm reduction primary care programs in New York State that care for people who use drugs and offer buprenorphine, one rural (Ithaca) and one urban (Manhattan), we have rapidly adopted telemedicine to initiate buprenorphine treatment. Our collective experience suggests that telemedicine for buprenorphine initiation is eliminating many traditional barriers to treatment, in particular for individuals leaving incarceration, and people who use drugs and access syringe service programs. Future models of buprenorphine treatment should incorporate telemedicine for buprenorphine initiation, which can be done in collaboration with community-based outreach and peer networks to engage people who use drugs. This regulatory change must be sustained beyond COVID-19, and is vital to increasing access to buprenorphine, closing the opioid use disorder treatment gap, and achieving greater health equity for people who use drugs.


Subject(s)
Buprenorphine/therapeutic use , COVID-19 , Health Services Accessibility , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders , Telemedicine/trends , Humans , New York , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/rehabilitation , Primary Health Care , Rural Population , Urban Population
9.
Addict Sci Clin Pract ; 16(1): 4, 2021 01 07.
Article in English | MEDLINE | ID: covidwho-1060377

ABSTRACT

The COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic's broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.


Subject(s)
COVID-19/psychology , Models, Psychological , Opioid-Related Disorders/psychology , Pandemics , Social Environment , COVID-19/epidemiology , COVID-19/rehabilitation , Comorbidity , Humans , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/rehabilitation , Prevalence , Public Policy , Research , Risk
11.
J Subst Abuse Treat ; 124: 108283, 2021 05.
Article in English | MEDLINE | ID: covidwho-1039464

ABSTRACT

Despite its proven efficacy, buprenorphine remains dramatically underutilized for management of opioid use disorder largely due to onerous barriers to treatment initiation. During the COVID-19 pandemic, many substance use disorder treatment facilities have reduced their hours and services, exacerbating existing barriers. To this end, the U.S. Drug Enforcement Administration and Substance Abuse Mental Health Services Administration adjusted their guidelines to allow for new buprenorphine prescriptions following audio-only telehealth encounters, no longer requiring an in-person evaluation prior to treatment initiation. Under this new guidance, we established a 24/7 telephone hotline to function as a "tele-bridge" clinic where people with opioid use disorder can be linked with a buprenorphine prescriber in real-time for OUD assessment and unobserved buprenorphine initiation with connection to follow-up if appropriate. Additionally, we developed an ED callback protocol to reach patients recently seen for opioid overdose and facilitate their entry into care if interested. In this commentary we describe our hotline and ED callback protocols, discuss theoretical and anecdotal benefits to this approach, and advocate for continuation of current regulatory changes post-COVID-19 to maintain expanded access to novel treatment approaches.


Subject(s)
Buprenorphine/therapeutic use , COVID-19 , Health Services Accessibility , Methadone/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , Telemedicine , Buprenorphine/supply & distribution , Emergency Service, Hospital , Humans , Methadone/supply & distribution , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , Rhode Island
12.
J Subst Abuse Treat ; 123: 108246, 2021 04.
Article in English | MEDLINE | ID: covidwho-1019323

ABSTRACT

Methadone maintenance treatment (MMT) in the United States, and particularly the clinic system of distribution, is often criticized as punitive, over-regulated, and misaligned to the needs of many patients. However, changes to the regulations that COVID-19 caused may have provided an opportunity for improving service. This commentary uses literature and my own experience to provide a brief description of how MMT programs responded to the threat of Covid-19 and how such responses fit into the larger context of attempts to reform treatment. It discusses, in particular, opportunities for liberalizing "take-home" doses and implementing office-based MMT.


Subject(s)
COVID-19 , Methadone , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , SARS-CoV-2 , Humans , Quality Improvement
13.
Addict Sci Clin Pract ; 16(1): 4, 2021 01 07.
Article in English | MEDLINE | ID: covidwho-1015904

ABSTRACT

The COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic's broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.


Subject(s)
COVID-19/psychology , Models, Psychological , Opioid-Related Disorders/psychology , Pandemics , Social Environment , COVID-19/epidemiology , COVID-19/rehabilitation , Comorbidity , Humans , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/rehabilitation , Prevalence , Public Policy , Research , Risk
14.
J Subst Abuse Treat ; 124: 108266, 2021 05.
Article in English | MEDLINE | ID: covidwho-1009704

ABSTRACT

People who use drugs (PWUD) often experience barriers to preventative health care. During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, we hypothesized that HIV testing in PWUD would decrease. To answer this question, we compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use-a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score-admitted between January, 2020 and August, 2020. The outcome of interest was HIV test completion during inpatient hospitalization. The study used logistic regression to examine associations between type of substance use and receipt of HIV test. The study grouped substance use type into four groups (1) opioids (oxycodone, fentanyl, or other opiates) or opioid use disorder treatments (methadone, buprenorphine, naltrexone); (2) stimulant use (cocaine or amphetamines); (3) alcohol use (presence of a positive CAGE or CIWA score or alcohol present on toxicology screen); and (4) benzodiazepine use (benzodiazepines present on toxicology screen). The proportion of PWUD who were tested for HIV increased from 10.4% in January, 2020 to 28.2% in April, 2020 and back down to 12% in August. Notably, there was an inverse trend over time for number of people hospitalized with drug use, from 259 in January to a nadir of 85 in April, and then up to 217 in August, 2020. Contrary to our hypothesis, HIV testing increased during the COVID-19 pandemic, and we discuss explanations for this finding. The decrease in HIV testing post-pandemic peak is a reminder that we must work to develop interventions that lead to sustained high rates of HIV testing for all people, and especially for PWUD.


Subject(s)
Alcoholism , Analgesics, Opioid/adverse effects , COVID-19 , Fentanyl/adverse effects , HIV Testing/statistics & numerical data , Hospitalization/statistics & numerical data , Buprenorphine/therapeutic use , Cocaine , Humans , Massachusetts , Opioid-Related Disorders/rehabilitation , Time Factors
15.
J Subst Abuse Treat ; 124: 108273, 2021 05.
Article in English | MEDLINE | ID: covidwho-1002833

ABSTRACT

The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Opioid-Related Disorders , Prenatal Care , Telemedicine , Female , Humans , New England , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/rehabilitation , Postpartum Period , Pregnancy , Safety-net Providers , United States
16.
J Subst Abuse Treat ; 123: 108263, 2021 04.
Article in English | MEDLINE | ID: covidwho-988546

ABSTRACT

The U.S. government declared the opioid epidemic as a national public health emergency in 2017, but regulatory frameworks that govern the treatment of opioid use disorder (OUD) through pharmaceutical interventions have remained inflexible. The emergence of the COVID-19 pandemic has effectively removed regulatory restrictions that experts in the field of medications for opioid use disorder (MOUD) have been proposing for decades and has expanded access to care. The regulatory flexibilities implemented to avoid unnecessary COVID-related death must be made permanent to ensure that improved access to evidence-based treatment remains available to vulnerable individuals with OUD who otherwise face formidable barriers to MOUD. We must seize this moment of COVOD-19 regulatory flexibilities to demonstrate the feasibility, acceptability, and safety of delivering treatment for OUD through a low-threshold approach.


Subject(s)
COVID-19 , Health Services Needs and Demand , Opiate Substitution Treatment/trends , Opioid-Related Disorders/rehabilitation , SARS-CoV-2 , Buprenorphine/administration & dosage , Buprenorphine/therapeutic use , Humans , Methadone , Narcotic Antagonists/administration & dosage , Narcotic Antagonists/therapeutic use , United States
17.
Int J Drug Policy ; 90: 103088, 2021 04.
Article in English | MEDLINE | ID: covidwho-987499

ABSTRACT

BACKGROUND: Amid the opioid crisis, the health care system is restructuring to prevent and treat COVID-19. Individuals in opioid agonist treatment (OAT) are uniquely challenged because of disruption to treatment, medication diversion, and isolation during the pandemic. METHODS: Between January and September 2020, we utilized the electronic medical record from a chain of 67 opioid agonist treatment clinics in Ontario, Canada, to examine routinely collected urine drug screen results of patients in opioid agonist treatment by Public Health Units. RESULTS: We present evidence of a 108% increase in the percentage of fentanyl positive urine drug screens from April to September (p< 0.001). During the same period, health regions in northern and southwestern Ontario, areas with a high concentration of rural communities, have seen the most notable increase in the percent of fentanyl positive urine drug screen results. CONCLUSION: The use of fentanyl increased by 108% among OAT patients in Ontario during the COVID 19 pandemic. We argue that the persistent increase of fentanyl exposure over time, specifically in the OAT population, suggests that reduced monitoring may decrease OAT's effectiveness and negatively impact patient outcomes.


Subject(s)
Analgesics, Opioid/therapeutic use , Analgesics, Opioid/urine , COVID-19 , Fentanyl/urine , Opiate Substitution Treatment , Opioid Epidemic , Opioid-Related Disorders/rehabilitation , Substance Abuse Detection , Substance Abuse Treatment Centers , Humans , Ontario , Opioid-Related Disorders/diagnosis , Opioid-Related Disorders/urine , Predictive Value of Tests , Urinalysis
18.
J Subst Abuse Treat ; 124: 108223, 2021 05.
Article in English | MEDLINE | ID: covidwho-957257

ABSTRACT

COVID-19 necessitated rapid changes in methadone take-home policies in opioid treatment programs (OTPs); these changes markedly contrast with existing, long-standing federal mandates on OTP rules about take-home methadone. OTP providers describe how these changes have affected clinical decision-making, equity in patient care, and workflow. We also discuss implications for medical ethics and patient autonomy. We provide suggestions for future research that will examine the impact of COVID-19 on OTP treatment and its patients, as well as the effect of making methadone take-home polices patient centered, all of which may foreshadow larger changes in the ways OTPs deliver their services.


Subject(s)
COVID-19 , Clinical Decision-Making/ethics , Health Personnel/psychology , Methadone/therapeutic use , Opioid-Related Disorders/drug therapy , Health Services Accessibility , Humans , Methadone/supply & distribution , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , Workflow
19.
J Subst Abuse Treat ; 124: 108221, 2021 05.
Article in English | MEDLINE | ID: covidwho-957255

ABSTRACT

The COVID-19 pandemic has presented challenges for traditional models of opioid use disorder treatment worldwide. Depot buprenorphine became available in Australia shortly before the height of the COVID-19 pandemic. This timing provided us an opportunity to examine the utilization and uptake of depot buprenorphine, and to understand the particular benefits and implementation challenges associated with this new formulation of opioid agonist treatment.


Subject(s)
Buprenorphine/therapeutic use , COVID-19/prevention & control , Delayed-Action Preparations/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , Australia , Buprenorphine/supply & distribution , Humans , Injections, Subcutaneous , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , Quarantine
20.
J Subst Abuse Treat ; 124: 108216, 2021 05.
Article in English | MEDLINE | ID: covidwho-957252

ABSTRACT

The Franklin County Sheriff's Office (FCSO), in Greenfield, Massachusetts, is among the first jails nationwide to provide correctional populations with access to all three medications to treat opioid use disorder (MOUD, i.e., buprenorphine, methadone, naltrexone). In response to the COVID-19 pandemic, FCSO quickly implemented comprehensive mitigation policies and adapted MOUD programming. Two major challenges for implementation of the MOUD program were the mandated rapid release of nonviolent pretrial individuals, many of whom were being treated with MOUD and released too quickly to conduct continuity of care planning; and establishing how to deliver physically distanced MOUD services in jail. FCSO implemented and adapted a hub-and-spoke MOUD model, developed telehealth capacity, and experimented with take-home MOUD at release to facilitate continuity-of-care as individuals re-entered the community. Experiences underscore how COVID-19 accelerated the uptake and diffusion of technology-infused OUD treatment and other innovations in criminal justice settings. Looking forward, to address both opioid use disorder and COVID-19, jails and prisons need to develop capacity to implement mitigation strategies, including universal and rapid COVID-19 testing of staff and incarcerated individuals, and be resourced to provide evidence-based addiction treatment. FCSO quickly pivoted and adapted MOUD programming because of its history of applying public health approaches to address the opioid epidemic. Utilizing public health strategies can enable prisons and jails to mitigate the harms of the co-occurring epidemics of OUD and COVID-19, both of which disproportionately affect criminal justice populations, for persons who are incarcerated and the communities to which they return.


Subject(s)
Buprenorphine/therapeutic use , COVID-19 , Methadone/therapeutic use , Naltrexone/therapeutic use , Opioid-Related Disorders , Prisoners , Humans , Massachusetts , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/rehabilitation , Prisons/organization & administration , Public Health , Telemedicine/organization & administration
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