Understanding the Effect of the COVID-19 Pandemic on Substance Use Disorder Treatment Facility Operations and Patient Success: Evidence From Mississippi.

Background: The COVID-19 pandemic has led to disruptions in the provision of care at substance use disorder (SUD) treatment facilities. Stresses associated with the pandemic could also negatively impact treatment outcomes for clients. The aim of this study is to evaluate how SUD treatment facilities in Mississippi changed their operations following the start of the pandemic. The change in client success rates at the facilities is also assessed. Methods: An online survey was completed by 12 SUD treatment facilities in Mississippi between February and May 2021. Results: Generally, the facilities' capacity to provide treatment to clientele was moderately affected by the pandemic. Facilities in the sample also adapted a variety of policies to limit the spread of COVID-19. Changes in the services provided by facilities was observed in the survey responses. For client success rates reported by the facilities, there was a decrease in the number of facilities stating that more than 80% of their clients completed treatment across the pre- and post-pandemic periods. However, the number of facilities with more than 80% of their clients successfully finishing treatment has increased in recent months. Conclusions: To continue serving their clientele during the pandemic, facilities enacted COVID-19-related policies and began offering new services such as telehealth. Although client success rates decreased at the beginning of the pandemic, they have returned to pre-pandemic levels in recent months. Our results indicate that SUD treatment facilities and clients have improved in terms of giving and receiving care as the pandemic has progressed.

Do prescription drug monitoring programs encourage prescription - or illicit - opioid abuse?

BACKGROUND: Prescription drug monitoring programs (PDMPs) are tools that states can use to fight prescription opioid misuse within their jurisdiction. However, because PDMPs make prescription opioids more difficult to access, these programs may have the unintended consequence of increasing deaths related to illicit opioids. Methods: This study uses fixed effects models to estimate how PDMP regulatory strength is associated with both prescription opioid- and heroin-related deaths between 1999 and 2016. PDMP regulatory strength is measured by creating a score using multiple correspondence analysis (MCA). Additional models replace the MCA score with a binary indicator for the presence of one particular regulation requiring physicians to access the system before writing opioid prescriptions. Results: Results show that continuous measures of PDMP strength are not generally associated with prescription opioid- or heroin-related death rates. Yet, one model does show that PDMP scores are positively associated with the heroin-related death rate. The models using the binary mandatory access variable show a strong positive association with both prescription opioid and heroin deaths. Conclusions: This study supports the theory that more stringent state PDMPs are associated with higher rates of heroin-related deaths, potentially due to decreases in prescription opioid availability.

Community Meetings on the Rural Opioid Crisis: Setting a Path Forward by Learning from Others.

OBJECTIVES: This study implemented a series of meetings in one rural community struggling with the opioid crisis. Set in the town of Ardmore, Oklahoma, these meetings presented local residents who dealt with the crisis as part of their jobs with four categories of programs aimed at preventing and treating opioid-related issues. The ultimate goal was for the participants to develop a consensus about where resources should be appropriated in the future, based off the needs of the area. METHODS: Three community meetings were held over a six-week period, with an average of 40 attendees. Data was collected through surveys, study circles, and a participant voting exercise. Surveys were distributed at the beginning and end of the meetings to determine if participant views changed over the course of the study. Study circles broke participants into small groups and prompted them with questions regarding the crisis to encourage group discussion. The participant voting exercise allowed participants to note where they would like future resources to be directed. FINDINGS: Listening to experts and holding group discussions led to changes in opinions for some participants. Most felt that the most pressing need was to provide accessible opioid treatment options in their community. Youth-based prevention efforts were also noted as being a program that the community should focus on. CONCLUSIONS: Local perceptions of the most appropriate strategies for combatting the rural opioid crisis can change with group discussions alongside others who are actively involved with this issue. Future research should actively involve affected communities in order to develop relevant and accepted action plans.

Are Rural Opioid Treatment Program (OTP) Facilities Associated with Lower Deaths?

Objectives: Rural areas have been particularly affected by the opioid epidemic in the U.S., with treatment options being scarce. This study focuses on opioid treatment programs (OTPs), which combine counseling services and opioid-related medication provision. In the South census region (comprised of 16 states and D.C.), 156 urban counties and 27 rural counties contained OTPs as of 2013. We examine whether their presence is associated with lower opioid-related death rates during 2014-2016. Methods: Coarsened exact matching (CEM) is used to match treated and untreated counties on demographic characteristics and opioid-related deaths from 2011 to 2013. Two treatments are considered: (1) if a county had an OTP in 2013; and (2) if an OTP existed in a neighboring county in 2013. The matched samples are then used in weighted least square regression models, with propensity score matching serving as a robustness check. Rural and urban counties are analyzed separately to determine if the impact of OTPs differs between these areas. Results: Results show that the presence of an OTP mostly has no statistical association with the rate of (or change in) future opioid deaths, in either rural or urban counties. Proximity to a neighboring county OTP displays a similar lack of association. Conclusions: The findings suggest that OTPs are not associated with fewer opioid-related deaths in the South over the near term, regardless of rural or urban location. These results could be attributed to outside factors that hinder this relationship. Continued assessment of varied approaches to the rural opioid crisis is encouraged.