Benefits and Future Relevance of the Corona-Related Temporary Changes in OST in Germany Results of a Qualitative Survey of Substituting Physicians

ABSTRACT

Purpose The COVID-19 pandemic has posed major challenges to OST (opioid substitution treatment). Therefor the legal basis (BtM-VV), which is often regarded as restrictive, was temporarily amended to give treatment providers more options in adapting therapies to the specific situation. Extensive flexibility was introduced in the areas of take-home prescriptions, consultative treatment and delegation. Additionally, new reimbursement options were created (EBM). An evaluation of the temporary changes of the legal and remuneration regulations was carried out through guided interviews with physicians providing OST. Methods In 2021, 16 qualitative interviews were conducted with OST providing physicians from ten different federal states of Germany. Interviewees were asked about their experiences regarding Corona-related temporary legal and remuneration changes. Questions focused on whether the temporary flexibilities should be adopted permanently in post-pandemic regular practice. The interview guide also included questions on structural barriers, lack of junior staff, and stigmatization. Results Most physicians extended take-home prescriptions. Subsequently only one person experienced purely negative consequences. Overall, interviewees reported either no and/or positive changes in the course of the therapy. The physicians used most of the temporary legal and remuneration flexibilities to adapt the treatment design. Predominantly interviewees have been in favour of adopting the temporary regulations in their post-pandemic practice. Controversial opinions were found on legal changes regarding the removal of the capacity limit in consultative regulation and expanded delegation. Conclusion The results support the adoption of the temporary legal and remuneration changes in post-pandemic practice. Changes facilitate the adaptation of therapy to individual circumstances of practitioners and patients. This might help to address current bottlenecks in the supply and to offer high-quality OST to more people with opioid use disorder. An identification and elimination of structural barriers should not be forgotten in the process of implementation. As legal flexibilization inevitably transfers more responsibility to the individual physician increased support via training and networking should be offered.