Impact of COVID-19 on the characteristics of opioid overdose deaths in Arkansas

Rezaeiahari, Mandana; Fairman, Brian J.

doi:10.1016/j.drugpo.2022.103836

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…23 Opioid overdose deaths have increased in Arkansas since 2017, with opioids accounting for a higher percentage of overall overdose deaths from 2017 to 2020. 24 …”

Section: Introductionmentioning

confidence: 99%

Primary Care Providers’ Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic

Marshall,

Siebenmorgen,

Youngen

et al. 2024

J Prim Care Community Health

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Background: The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. Methods: Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. Results: The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. Conclusion: This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth’s value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

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“…23 Opioid overdose deaths have increased in Arkansas since 2017, with opioids accounting for a higher percentage of overall overdose deaths from 2017 to 2020. 24 …”

Section: Introductionmentioning

confidence: 99%

Primary Care Providers’ Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic

Marshall,

Siebenmorgen,

Youngen

et al. 2024

J Prim Care Community Health

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“…The goal of the SAMHSA policy change was to protect public health by lowering the risk of COVID-19 infections among patients and health care clinicians (ie, accommodate social distancing while supporting patient care for treatment of opioid use disorder). Results of research on the effects of the policy change are still emerging, but the weight of the evidence suggests that the policy change was associated with an increase in the number of patients receiving take-home doses and that it did not adversely affect treatment outcomes, including fatal overdoses . A set of proposals that will permanently ease the take-home restrictions is now being considered by SAMHSA .…”

Section: Introductionmentioning

confidence: 99%

“…Results of research on the effects of the policy change are still emerging, but the weight of the evidence suggests that the policy change was associated with an increase in the number of patients receiving take-home doses and that it did not adversely affect treatment outcomes, including fatal overdoses. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 A set of proposals that will permanently ease the take-home restrictions is now being considered by SAMHSA. 13 To our knowledge, only 1 study has investigated the association between relaxing methadone restrictions and fatal overdoses among different racial, ethnic, or sex groups, 14 although prior research suggests a strong possibility of demographic differences in outcomes.…”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

et al. 2023

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ImportanceIn March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures.ObjectiveTo assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups.Design, Setting, and ParticipantsInterrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.ExposureOn March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients.Main Outcome MeasuresMonthly methadone-involved overdose deaths.ResultsFrom January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study’s 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, −0.55 [95% CI, −0.95 to −0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (−0.42 [95% CI, −0.68 to −0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, −0.27 [95% CI, −1.13 to 0.59]; Hispanic women, 0.29 [95% CI, −0.46 to 1.04]; White men, –0.08 [95% CI, −1.05 to 0.88]; and White women, −0.43 [95% CI, −1.26 to 0.40]).Conclusions and RelevanceIn this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

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“…In response to COVID-19 public health measures, healthcare systems implemented remote care solutions, transforming the delivery of healthcare services [14] and accelerating the adoption and utilization of virtual healthcare [15][16][17]. During this same period, much of the progress that had been made to address the opioid crisis was reversed [18][19][20]; illicit drug poisoning deaths increased as a result of limited health services [21], poisoned supply [22], and solitary drug use [23]. In the context of these challenges, and as a result of pandemic-related public health measures, virtual care emerged as a potential solution to address the unique needs of PWOUD by providing essential healthcare services remotely [24].…”

Section: Introductionmentioning

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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Impact of COVID-19 on the characteristics of opioid overdose deaths in Arkansas

Cited by 9 publications

References 20 publications

Primary Care Providers’ Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic

Primary Care Providers’ Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

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

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