Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years.

INTRODUCTION: In response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents-safety events occurring in OTPs that are reportable to regulatory entities-across all Colorado OTPs during the COVID-19 pandemic. METHODS: This study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15-December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15-December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. RESULTS: OTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). CONCLUSIONS: There was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.

In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder.

INTRODUCTION: Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP. AIM: Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage. SETTING: Seven hundred-bed university hospital in Aurora, CO. PROGRAM DESCRIPTION: A physician dually affiliated with a hospital's addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins. PROGRAM EVALUATION METRICS: IN-MEET enrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments. RESULTS: Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7 years, standard deviation [SD] 11.2 years vs. 36.1 years, SD 10.6 years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%). CONCLUSION: IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.