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USA. Cambridge Health Alliance's Experience During COVID: Providing Care to Our OUD Patient Population

When the COVID-19 pandemic hit us in March 2020, providers at Cambridge Health Alliance (CHA) were confronted with a dilemma: how do we continue to help our patients with opioid use disorder (OUD) remain in recovery?

Across our health system, CHA provides the majority of our OUD care via group-based opioid treatment (GBOT). In this model, patients who struggle with OUD come together for an hour-long shared medical appointment, in which they provide support to each other, discuss a topic of interest or participate in psychotherapeutic activity, and they receive their Buprenorphine-naloxone (B/N) prescriptions.

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While CHA had been providing GBOT as a treatment approach for our OUD patients for many years, the pandemic abruptly put a stop to this delivery model. Patients who had benefited from the social support of the group were now expected to socially isolate themselves. How would they get the support they needed? And, how would they get their B/N prescriptions? How would we do urine drug tests on them?

When CHA as an entire health system converted to televisits (i.e., conducting our visits exclusively via phone or video), we decided to do the same with our OUD patients. (BASIS online, Cambridge Health Alliance / Harvard Medical School – Teaching Hospital, USA, 13.09.2021)

https://www.basisonline.org/2021/09/cha-covid-experience-oud-patient-population.html

Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia. 

Lintzeris N, Deacon RM, Hayes V, Cowan T, Mills L, Parvaresh L, Harvey Dodds L, Jansen L, Dojcinovic R, Leung MC, Demirkol A, Finch T, Mammen K. 

Drug Alcohol Rev. 2021 Sep 14. doi: 10.1111/dar.13382. Epub ahead of print. PMID: 34520592.

https://onlinelibrary.wiley.com/doi/10.1111/dar.13382

Buprenorphine Dispensing in Pennsylvania During the COVID-19 Pandemic, January to October 2020. 

Chalasani R, Shinabery JM, Goetz CT, Chang CH, Yang Q, Suda KJ, Gellad WF. 

J Gen Intern Med. 2021 Aug 10:1–3. doi: 10.1007/s11606-021-07083-y. Epub ahead of print. PMID: 34378112; PMCID: PMC8354093.

https://link.springer.com/article/10.1007%2Fs11606-021-07083-y

Effects of COVID-19 on Substance Use in Singapore. 

Tan HT, Chai BC, Lui YS. 

Subst Abuse. 2021 Aug 24;15:11782218211030533. doi: 10.1177/11782218211030533. PMID: 34456569; PMCID: PMC8392814.

https://pubmed.ncbi.nlm.nih.gov/34456569/

Serious health threats of novel adulterants of the street heroin: a report from India during the COVID-19 pandemic.

Mahintamani T, Ghosh A, Jain R.

BMJ Case Rep. 2021 Aug 25;14(8):e242239. doi: 10.1136/bcr-2021-242239. PMID: 34433525.

https://casereports.bmj.com/content/14/8/e242239.long

Drug consumption during prolonged lockdown due to Covid-19 as observed in French addiction center. 

Chappuy M, Peyrat M, Lejeune O, Duvernay N, David B, Joubert P, Lack P. 

Therapie. 2021 Jul-Aug;76(4):379-382. doi: 10.1016/j.therap.2021.01.053. Epub 2021 Jan 20. PMID: 33516544; PMCID: PMC7817436.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817436/

Did drug use increase following COVID-19 relaxation of methadone take-out regulations? 2020 was a complicated year. 

Bart G, Wastvedt S, Hodges JS, Rosenthal R. 

J Subst Abuse Treat. 2021 Aug 6:108590. doi: 10.1016/j.jsat.2021.108590. Epub ahead of print. PMID: 34373169; PMCID: PMC8343384.

https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(21)00316-0/fulltext

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder. 

Weintraub E, Seneviratne C, Anane J, Coble K, Magidson J, Kattakuzhy S, Greenblatt A, Welsh C, Pappas A, Ross TL, Belcher AM.

JAMA Netw Open. 2021 Aug 2;4(8):e2118487. doi: 10.1001/jamanetworkopen.2021.18487. PMID: 34448869.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783548

Opioid overdose crises during the COVID-19 pandemic: implication of health disparities. 

Patel I, Walter LA, Li L. 

Harm Reduct J. 2021 Aug 16;18(1):89. doi: 10.1186/s12954-021-00534-z. PMID: 34399771; PMCID: PMC8365290.

https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00534-z

COVID-19 and Opioid Use in Appalachian Kentucky: Challenges and Silver Linings. 

Vickers-Smith R, Cooper HLF, Young AM. 

J Appalach Health. 2020 Fall;2(4):11-16. doi: 10.13023/jah.0204.03. PMID: 34350421; PMCID: PMC8330514.

https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1093&context=jah

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs. 

Kesten JM, Holland A, Linton MJ, Family H, Scott J, Horwood J, Hickman M, Telfer M, Ayres R, Hussey D, Wilkinson J, Hines LA. 

Int J Drug Policy. 2021 Jul 20;98:103391. doi: 10.1016/j.drugpo.2021.103391. Epub ahead of print. PMID: 34343945; PMCID: PMC8289673.

https://www.sciencedirect.com/science/article/pii/S0955395921002966

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review. 

Alexander K, Pogorzelska-Maziarz M, Gerolamo A, Hassen N, Kelly EL, Rising KL. 

Subst Abuse Treat Prev Policy. 2021 Aug 9;16(1):60. doi: 10.1186/s13011-021-00395-6. PMID: 34372900; PMCID: PMC8352141.

https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00395-6

Treating Opioid Use Disorder in Puerto Rico During the COVID-19 Pandemic: Providers' Leadership Efforts in Unprecedented Times. 

Quiñones DS, Melin K, Roman L, Rodriguez F, Alvarado J, Rodríguez-Díaz CE. 

J Addict Med. 2021 Jul-Aug 01;15(4):276-279. doi: 10.1097/ADM.0000000000000764. PMID: 33229933; PMCID: PMC8327765.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327765/

Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond. 

Brett A, Foster H, Joseph M, Warrington JS. 

J Patient Exp. 2021 Jul 29;8:23743735211033128. doi: 10.1177/23743735211033128. PMID: 34377769; PMCID: PMC8330461.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330461/

Challenges in delivering telemedicine to vulnerable populations: experiences of an addiction medical service during COVID-19. 

Hew A, Arunogiri S, Lubman DI. 

Med J Aust. 2021 Aug 7. doi: 10.5694/mja2.51213. Epub ahead of print. PMID: 34365643.

https://onlinelibrary.wiley.com/doi/10.5694/mja2.51213

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID-19 pandemic. 

Hughes PM, Verrastro G, Fusco CW, Wilson CG, Ostrach B. 

J Rural Health. 2021 Jun;37(3):467-472. doi: 10.1111/jrh.12570. Epub 2021 Mar 15. PMID: 33720447; PMCID: PMC8250742.

https://onlinelibrary.wiley.com/doi/10.1111/jrh.12570

Impact of the Coronavirus Pandemic on Substance Use Disorder Treatment: Findings from a Survey of Specialty Providers in California. 

Henretty K, Padwa H, Treiman K, Gilbert M, Mark TL. 

Subst Abuse. 2021 Jul 6;15:11782218211028655. doi: 10.1177/11782218211028655. PMID: 34285496; PMCID: PMC8264730.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264730/

USA. How COVID pandemic changed methadone treatment for addiction

Here’s one more lesson from the COVID-19 pandemic: It appears safe to relax restrictions on methadone, the oldest and most stigmatized treatment drug for opioid addiction. (AP, 12.08.2021)

https://apnews.com/article/science-health-pandemics-coronavirus-pandemic-c36442b3fe8f2074e2fe3907d11ca579

Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19. 

Davis CS, Samuels EA. 

Int J Drug Policy. 2021 Jul;93:102905. doi: 10.1016/j.drugpo.2020.102905. Epub 2020 Aug 15. PMID: 32811685; PMCID: PMC7428767.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428767/

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada. 

Joudrey PJ, Adams ZM, Bach P, Van Buren S, Chaiton JA, Ehrenfeld L, Guerra ME, Gleeson B, Kimmel SD, Medley A, Mekideche W, Paquet M, Sung M, Wang M, You Kheang ROO, Zhang J, Wang EA, Edelman EJ. 

JAMA Netw Open. 2021 Jul 1;4(7):e2118223. doi: 10.1001/jamanetworkopen.2021.18223. PMID: 34297070.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782211

Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies. 

Henderson R, McInnes A, Mackey L, Bruised Head M, Crowshoe L, Hann J, Hayward J, Holroyd BR, Lang E, Larson B, Leonard AJ, Persaud S, Raghavji K, Sarin C, Virani H, Wadsworth IW, Whitman S, McLane P. 

BMC Public Health. 2021 Jul 28;21(1):1471. doi: 10.1186/s12889-021-11495-0. PMID: 34320954; PMCID: PMC8318046.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318046/

Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. 

Galarneau LR, Hilburt J, O’Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, et al. (2021) 

PLoS ONE 16(7): e0255396. doi.org/10.1371/journal.pone.0255396

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255396

USA. Pandemic-based approach to methadone treatment restrictions should remain

When the COVID-19 pandemic ripped through New England and the rest of the United States in early 2020, substance use disorder treatment centers were forced to make massive changes to minimize the spread of coronavirus. 

The fear of COVID-19 spread into crowded treatment programs run by the national Substance Abuse and Mental Health Services Administration, prompting them to relax stringent federal regulations on distributing methadone, a common treatment for opioid use. The agency allowed programs to increase the number of take-home methadone doses that patients could receive and reduce the frequency of counseling and drug testing—changes that sparked concerns over medication diversion and lapses in treatment. 

But a new study by researchers at the Yale School of Public Health finds that these concerns appear unfounded. Relaxing the requirements for dispensing take-home methadone treatments did not significantly lead to an increase in fatal methadone-related overdoses in Connecticut at all, they found. The changes also did not result in reductions in the number of patients receiving treatment for their opioid use disorder.

Furthermore, the findings suggest that the changes to the restrictions on methadone implemented during the pandemic should continue indefinitely to improve access to the drug, the researchers wrote. (MedicalXpress, USA, 21.07.2021)

https://medicalxpress.com/news/2021-07-pandemic-based-approach-methadone-treatment-restrictions.html

Changes in methadone program practices and fatal methadone overdose rates in Connecticut during COVID-19

Brothers, Sarah et al.

Journal of Substance Abuse Treatment, Volume 131, 108449 

https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(21)00175-6/fulltext

Coronavirus (COVID-19) opioid substitution treatment in prisons - evaluation: patient experience follow-up report

Follow up report on opiate substitution therapy (OST) in Scotland’s prison during COVID-19. This report explores the experiences of patients living in prisons changing their OST prescription to Buvidal.

Scottish Government, Population Health Directorate. 07.07.2021, ISBN:

9781802011289

https://www.gov.scot/publications/evaluation-opioid-substitution-treatment-scotlands-prisons-covid-19-contingency-patient-experience-follow-up-report/

Irland. Methadone users may have better protection against Covid

Numbers of infections in people in treatment for heroin addiction far lower than expected. (Irish Times, Irland, 20.07.2021)

https://www.irishtimes.com/news/health/methadone-users-may-have-better-protection-against-covid-1.4625125

Australien. The impact of COVID-19 on people receiving Opioid Agonist Treatment (OAT)

This presentation drew on the experiences of people receiving and providing Opioid Agonist Treatment (OAT) during COVID-19.

The COVID-19 pandemic required Opioid Agonist Treatment (OAT) services to adapt quickly to ensure continuity of care. The CHOICE Study uses data collected from 70 in-depth interviews (40 people receiving OAT; 30 providers) to explore how OAT services in Australia responded to COVID-19 and the wider implications of the pandemic for people receiving OAT. Study findings will inform clinical practice and health policy, and highlight areas of future research for people who are dependent on opioids. (Anna Conway presented at the NDARC - National Drug and Alcohol Research Centre

 Webinar Series on Thursday 22 July 2021.)

https://ndarc.med.unsw.edu.au/resource/impact-covid-19-people-receiving-opioid-agonist-treatment-oat

A cross-section observational study on the seroprevalence of antibodies to COVID-19 in patients receiving opiate agonist treatment. 

Fenton, F., Stokes, S. & Eagleton, M. 

Ir J Med Sci (2021). doi.org/10.1007/s11845-021-02660-w

https://link.springer.com/article/10.1007/s11845-021-02660-w

Opioidagonistentherapie: Wie nach der Pandemie alles besser werden soll

ÖGABS Expert*innen Web-Konferenz zum Thema „Versorgung von Suchtpatient*innen währendund nach der Corona-Krise. Ein Follow-up im Ländervergleich zwischen Deutschland, Schweiz undÖsterreich“, 5. März 2021

Die in der Opioidagonistentherapie (OAT) tätigen Zentren in Österreich, Deutschland und derSchweiz sind bislang gut durch die COVID19-Pandemie gekommen. COVID-Erkrankungen von Patient*innen in OAT sind die Ausnahme geblieben. Flexibilisierung und Liberalisierung der Therapie wurden durch die Gegebenheiten erzwungen, haben sich bislang aber sogar als vorteilhaft für die Patient*innen erwiesen. Vieles, was in den letzten Monaten versucht wurde, soll in Zukunft beibehalten werden.

Opioidagonistentherapie - Wie nach der Pandemie alles besser werden soll

DIE STILLE NORMALISIERUNG (© A. SPRINGER) - „Versorgung von Suchtpatient*innen während und nach der Corona-Krise“ HANS HALTMAYER (Präsentation)

21. Interdisziplinärer Kongress für Suchtmedizin, 2.Juni 2021, München

Stille Normalisierung_H.Haltmayer-München 2021_last.pdf