Impact of reduced restrictions on buprenorphine prescribing during COVID-19 among patients in a community-based treatment program

Ward, Kathleen; Scheim, Ayden I.; Wang, Jonathan; Cocchiaro, Benjamin; Singley, Katie; Roth, Alexis M.

doi:10.1016/j.dadr.2022.100055

Cited by 20 publications

(20 citation statements)

References 37 publications

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“…20,21 Recent studies have reported that clinicians have used these emergency authorizations to initiate and continue buprenorphine treatment during the COVID-19 pandemic and that patients have benefited. [22][23][24] However, questions remain about whether there was an increase in buprenorphine-involved overdose deaths following implementation of these new emergency authorizations that removed historical measures intended to reduce diversion and misuse of buprenorphine.…”

Section: Introductionmentioning

confidence: 99%

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

et al. 2023

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ImportanceBuprenorphine remains underused in treating opioid use disorder, despite its effectiveness. During the onset of the COVID-19 pandemic, the US government implemented prescribing flexibilities to support continued access.ObjectiveTo determine whether buprenorphine-involved overdose deaths changed after implementing these policy changes and highlight characteristics and circumstances of these deaths.Design, Setting, and ParticipantsThis cross-sectional study used data from the State Unintentional Drug Overdose Reporting System (SUDORS) to assess overdose deaths in 46 states and the District of Columbia occurring July 2019 to June 2021. Data were analyzed from March 7, 2022, to June 30, 2022.Main Outcomes and MeasuresBuprenorphine-involved and other opioid-involved overdose deaths were examined. Monthly opioid-involved overdose deaths and the percentage involving buprenorphine were computed to assess trends. Proportions and exact 95% CIs of drug coinvolvement, demographics, and circumstances were calculated by group.ResultsDuring July 2019 to June 2021, 32 jurisdictions reported 89 111 total overdose deaths and 74 474 opioid-involved overdose deaths, including 1955 buprenorphine-involved overdose deaths, accounting for 2.2% of all drug overdose deaths and 2.6% of opioid-involved overdose deaths. Median (IQR) age was similar for buprenorphine-involved overdose deaths (41 [34-55] years) and other opioid–involved overdose deaths (40 [31-52] years). A higher proportion of buprenorphine-involved overdose decedents, compared with other opioid–involved decedents, were female (36.1% [95% CI, 34.2%-38.2%] vs 29.1% [95% CI, 28.8%-29.4%]), non-Hispanic White (86.1% [95% CI, 84.6%-87.6%] vs 69.4% [95% CI, 69.1%-69.7%]), and residing in rural areas (20.8% [95% CI, 19.1%-22.5%] vs 11.4% [95% CI, 11.2%-11.7%]). Although monthly opioid-involved overdose deaths increased, the proportion involving buprenorphine fluctuated but did not increase during July 2019 to June 2021. Nearly all (92.7% [95% CI, 91.5%-93.7%]) buprenorphine-involved overdose deaths involved at least 1 other drug; higher proportions involved other prescription medications compared with other opioid-involved overdose deaths (eg, anticonvulsants: 18.6% [95% CI, 17.0%-20.3%] vs 5.4% [95% CI, 5.2%-5.5%]) and a lower proportion involved illicitly manufactured fentanyls (50.2% [95% CI, 48.1%-52.3%] vs 85.3% [95% CI, 85.1%-85.5%]). Buprenorphine decedents were more likely to be receiving mental health treatment than other opioid–involved overdose decedents (31.4% [95% CI, 29.3%-33.5%] vs 13.3% [95% CI, 13.1%-13.6%]).Conclusions and RelevanceThe findings of this cross-sectional study suggest that actions to facilitate access to buprenorphine-based treatment for opioid use disorder during the COVID-19 pandemic were not associated with an increased proportion of overdose deaths involving buprenorphine. Efforts are needed to expand more equitable and culturally competent access to and provision of buprenorphine-based treatment.

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Section: Introductionmentioning

confidence: 99%

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

et al. 2023

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“…18 Other studies conducted in single-clinic settings have compared buprenorphine retention before and after shifting their treatment model from in-person to telehealth; these studies have observed mixed findings and have not compared retention between video and telephone modalities. [19][20][21][22][23] Studies are needed that compare both key patient characteristics and retention across buprenorphine treatment modalities following COVID-19-related policy changes among a national sample. As the largest OUD treatment provider in the US, 24 the Veterans Health Administration (VHA) is a particularly important setting in which to examine these questions.…”

Section: Introductionmentioning

confidence: 99%

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2022

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ImportanceThe coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention—a key indicator of care quality.ObjectivesTo compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19–related policy changes.Design, Setting, and ParticipantsThis cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19–related changes; prior to COVID-19–related changes).ExposuresPatient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person).Main Outcomes and MeasuresTreatment modality; 90-day retention.ResultsAmong 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19–related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19–related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71).Conclusions and RelevanceIn this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.

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“…Telemedicine and low-barrier MOUD have been used throughout the pandemic to reduce the negative impact the pandemic has had on patients with OUD and to increase buprenorphine prescribing [ 3 , 54 ]. It appears that less restrictive buprenorphine prescribing guidelines have led to increased access to buprenorphine [ 55 ] and improved retention in care [ 56 ]. Some have argued that the temporary changes in restrictions on MOUD prescribing should be made permanent so that vulnerable individuals with OUD do not face excess barriers to care [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of COVID-19 risk during the pandemic: perspectives from people seeking medication for opioid use disorder

et al. 2023

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Introduction The Coronavirus Disease 2019 (COVID-19) pandemic has had devastating consequences for persons with opioid use disorder (OUD). Yet, little is known about how people seeking treatment for OUD perceive the risks of COVID-19 and how their perception interplays with their health behaviours. Methods In-depth interviews were conducted from September 2021 to March 2022 with 32 patients seeking medication treatment for OUD (MOUD) in Southern California. All interviews were conducted virtually and lasted between one and two hours. Interviews were recorded and transcribed verbatim. Two qualitative researchers independently conducted a content analysis of the transcripts to identify themes. Results Three primary themes were identified: (1) perceptions and beliefs about COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed in their beliefs of susceptibility to contracting COVID-19 and the severity of the disease if contracted. Some participants reported taking precautions to mitigate their chances of acquiring COVID-19, and other participants reported that COVID was not a big concern as substance use took priority. For many of the participants, COVID-19 concerns were overshadowed by the risk of overdosing on substances and other risky substance use behaviour. Most of the participants ( n = 23; 72%) had received at least one COVID-19 vaccine by the time of the interview, but over half ( n = 19; 59%) expressed vaccine hesitancy. Vaccine hesitancy was driven by concerns about the unknown long-term side effects and potential interactions of the vaccine with MOUD. Conclusions Our study provides insight into COVID-19 prevention measures as well as vaccination perceptions and hesitancy among people who received treatment for OUD. Key messages Participants expressed diverse perceptions of the seriousness of COVID-19, with some taking precautions to mitigate their chances of acquiring COVID-19 and others perceiving that the risk of contracting COVID-19 was less than the risk of overdosing. Substance use, social isolation, vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring phenomena that have potentially overlapping relationships that can influence behaviours that impact health and well-being.

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Impact of reduced restrictions on buprenorphine prescribing during COVID-19 among patients in a community-based treatment program

Cited by 20 publications

References 37 publications

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

Perceptions of COVID-19 risk during the pandemic: perspectives from people seeking medication for opioid use disorder

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