Impact of the COVID-19 pandemic on opioid agonist treatment in Ireland: Protocol for an interrupted time series analysis

Abstract

While opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, it is heavily dependent on regular face-to-face healthcare delivery placing both clients and treatment providers at risk of COVID-19. Following the emergence of COVID-19, policies were rapidly changed in Ireland, with the introduction of national contingency guidelines by the HSE National Social Inclusion Office, beginning in March 2020 to ensure rapid and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risk. This study aims to assess the impact of the national contingency guidelines, on the quality of OAT care delivered in Ireland. An interrupted time series analysis will be conducted using anonymised aggregated level data obtained from the Central Treatment List (CTL), the national register of people receiving OAT, administered by the National Drug Treatment Centre Board on behalf of the HSE. Separate segmented regressions will be conducted to estimate the impact of the national contingency guidelines on the following outcomes: (1) number of patients in treatment; (2) number of patients starting OAT; (3) average waiting time for treatment; (4) number of people on waiting list; (5) number of patients dropping out of treatment. The study period will be divided into pre-(March 2019 to February 2020) and post- intervention (April 2020 to March 2021) segments. Immediate (change in level) and longer-term impacts (change in slope) of changes to provision of OAT in each of the outcomes will be investigated. Regression coefficients (β) and 95% confidence intervals (CIs) will be reported.

Health service utilisation and access for people who inject drugs during COVID‐19

“…The restructuring of OAT provision, which allowed for increases in take‐away dosing and electronic scripts for pharmacists, was a positive outcome for participants in our study, as has been highlighted in international studies [25]. Prior research has demonstrated multiple benefits of sustained OAT prescription for improving quality of life and in reducing hepatitis C incidence, criminal behaviour [26–28], and overdose risk [29], highlighting the imperative for continuing uninterrupted OAT provision.…”

Impact of Changes to the Delivery of Opioid Agonist Treatment, Introduced During the COVID-19 Pandemic, On Treatment Access and Dropout in Ireland: An Interrupted Time Series Analysis

“…This study is reported according to the STROBE Standardized Reporting Guidelines for Cross-Sectional Studies (Vandenbroucke et al, 2007). The study protocol is available on HRB Open (Cousins et al, 2021).…”

“…The study observed rates of dropout, accounting for the number of people in treatment on the last day of the previous month, to detect any variation to outcome (C). While we originally planned to assess the impact of changes introduced to the delivery of OAT on number of people on waiting lists and waiting time (Cousins et al, 2021), the required data were not available.…”