Changes to methadone maintenance therapy in the United States, Canada, and Australia during the COVID-19 pandemic: A narrative review

Panwala, Victoria; Joudrey, Paul J.; Kowalski, Melanie; Bach, Paxton; Amram, Ofer

doi:10.1016/j.josat.2023.209086

Cited by 6 publications

(2 citation statements)

References 57 publications

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“…Most studies were conducted in the United States, which can limit or challenge generalizability to other health system contexts. For example, regulations and billing, part of CFIR's Outer Setting, differ dramatically across settings [85][86][87]. While qualified physicians in both countries can prescribe buprenorphine, the United States previously required a waiver under the Drug Addiction Treatment Act, whereas there is no such requirement in Canada [88].…”

Section: Discussionmentioning

confidence: 99%

Virtual Primary Care for People with Opioid Use Disorder: A Scoping Review of Current Strategies, Benefits, and Challenges

Narayan,

Gooderham,

Spencer

et al. 2023

Preprint

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BackgroundThere is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. This scoping review synthesizes current literature on virtual primary care for people with opioid use disorder, with a specific focus on benefits, challenges, and strategies.MethodsWe followed the Joanna Briggs Institute methodological approach for scoping reviews and reported our findings consistent with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We conducted searches on MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the three concepts (i.e., virtual care; primary care; people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of studies using the Quality Assessment with Diverse Studies tool and categorized findings using the Consolidated Framework for Implementation Science.ResultsOur search identified 1474 studies. We removed 536 duplicates, leaving 936 studies for title and abstract screening. After a double review process, we retained 28 studies for extraction. Most studies described virtual primary care delivered via phone (n=18, 64.3%) rather than video. While increased healthcare accessibility was a significant benefit (n=13, 46.4%) to the adoption of virtual visits, issues around access to technology and digital literacy stood out as the main challenge (n=12, 42.9%).ConclusionsThe available studies highlight the potential for enhancing accessibility and continuous access care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure virtual primary care does not exacerbate or entrench health inequities.

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Section: Discussionmentioning

confidence: 99%

Virtual Primary Care for People with Opioid Use Disorder: A Scoping Review of Current Strategies, Benefits, and Challenges

Narayan,

Gooderham,

Spencer

et al. 2023

Preprint

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“…47 Methadone deregulation of OUD treatment in the United States to a community pharmacy-based distribution model resembling Canada and Australia has potential for increasing treatment retention and cost-effectiveness when compared to take-home flexible dosing buprenorphine. 48,49 The United States Congress is considering the Modernizing Opioid Treatment Access Act, which would allow physicians board-certified in addiction medicine or addiction psychiatry to prescribe methadone for OUD outside of OTP settings. 50 Critics raise concerns that this law could increase diversion and overdose risk while decreasing treatment retention.…”

Section: Methadonementioning

confidence: 99%

Managing Opioid Withdrawal Symptoms During the Fentanyl Crisis: A Review

Weber,

Trebach,

Brenner

et al. 2024

SAR

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Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF. Therefore, the focus was on therapeutic interventions published between January 2010 and November 2023, overlapping with the period of increasing IMF exposure. A health science librarian conducted a systematic search on November 13, 2023. A total of 426 studies were screened, and 173 studies were reviewed at the full-text level. Forty-nine studies met the inclusion criteria. Buprenorphine and naltrexone were included in most studies with the goal of transitioning to a long-acting injectable version. Various augmenting agents were tested (buspirone, memantine, suvorexant, gabapentin, and pregabalin); however, the liberal use of adjunctive medication and shortened timelines to initiation had the most consistently positive results. Outside of FDA-approved medications for OUD, lofexidine, gabapentin, and suvorexant have limited evidence for augmenting opioid agonist initiation. Trials often have low retention rates, particularly when opioid agonist washout is required. Neurostimulation strategies were promising; however, they were developed and studied early. Precipitated withdrawal is a concern; however, the rates were low and adequately mitigated or managed with low- or high-dose buprenorphine induction. Maintenance treatment continues to be superior to detoxification without continued management. Shorter induction protocols allow patients to initiate evidence-based treatment more quickly, reducing the use of illicit or non-prescribed substances.

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