Impact of the COVID-19 pandemic on the provision of take-home doses of opioid agonist therapy in Ontario, Canada: A population-based time-series analysis

Evaluating interventions to facilitate opioid agonist treatment access among people who inject drugs in Toronto, Ontario during COVID-19 pandemic restrictions

“…Another population-based analysis of OAT-enrolled Ontarians found that individuals who received increased take-home doses in the first 30 days following the interim treatment guidance (e.g., transitioned from daily observed dosing to any take-home doses) were significantly less likely to pause or discontinue treatment in the next six months versus those without increased take-home doses ( Gomes et al, 2022 ). Taken together with our findings, these results suggest that, as intended, the provincial interim treatment guidance led to increased provision of take-home doses to OAT patients both in the general population and our study cohort of structurally vulnerable PWID, which facilitated treatment retention in the early stages of the COVID-19 pandemic ( Gomes et al, 2022 ; Kitchen et al, 2022 ).…”

“…These inferences are supported by analogous findings from the broader OAT patient population in Ontario. A study by Kitchen et al observed that the number of Ontarians actively being treated with methadone or buprenorphine/naloxone was unchanged following the provincial COVID-19 emergency declaration and interim OAT guidance ( Kitchen et al, 2022 ). Though enrollment remained stable, as in our study, the interim treatment guidance was associated with immediate increases in the weekly proportions of OAT patients receiving extended supplies of take-home methadone or buprenorphine/naloxone doses (i.e., ≥7 days’ worth per dispensation) ( Kitchen et al, 2022 ).…”

“…A study by Kitchen et al observed that the number of Ontarians actively being treated with methadone or buprenorphine/naloxone was unchanged following the provincial COVID-19 emergency declaration and interim OAT guidance ( Kitchen et al, 2022 ). Though enrollment remained stable, as in our study, the interim treatment guidance was associated with immediate increases in the weekly proportions of OAT patients receiving extended supplies of take-home methadone or buprenorphine/naloxone doses (i.e., ≥7 days’ worth per dispensation) ( Kitchen et al, 2022 ). Another population-based analysis of OAT-enrolled Ontarians found that individuals who received increased take-home doses in the first 30 days following the interim treatment guidance (e.g., transitioned from daily observed dosing to any take-home doses) were significantly less likely to pause or discontinue treatment in the next six months versus those without increased take-home doses ( Gomes et al, 2022 ).…”

Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England

“…In summary, being prescribed OAT may have been protective, as the large increase in methadone-associated death seen in those out of treatment did not occur in those receiving a prescription. This is consistent with evidence prior to the COVID-19 pandemic that risk of death is lower for patients receiving OAT than those who have left treatment ( Sordo et al, 2017 ) and consistent with treatment cohort findings of no increase in overdose death during the pandemic ( Amram et al, 2021 , Kitchen et al, 2022 ). Other healthcare factors such as increased response times of emergency responders ( Goddard, 2022 ), reduced staffing to provide emergency treatment ( Propper et al, 2020 ), and reluctance to attend hospitals for fear of contracting COVID-19 ( Hughes et al, 2020 ), may have all increased the proportion of opioid overdoses which ultimately proved fatal but would arguably have affected both groups.…”

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study

“…While these findings are encouraging, as flexibility in take-away doses is valued by patients and associated with improved quality of life and retention ( Frank et al, 2021 ), they should be interpreted with caution as the risk of residual confounding remains ( Gomes et al, 2022 ). Furthermore, a subsequent analysis of the impact of COVID-19 on the provision of take-away doses of OAT in Ontario, Canada found that the observed flexibility in take-away doses was concentrated among individuals already receiving take-away doses pre-pandemic, with take-away prescribing trends reverting to pre-pandemic patterns towards the study end (November 2020) ( Kitchen et al, 2022 ). An assessment of the impact of increased take-away doses is required in Europe, as the EMCDDA recently reported concern regarding diversion and misuse of OAT medications in Europe, evidenced by an increase in the demand for specialized treatment related to the misuse of OAT medications, and the number of deaths associated with these medications over the past 10 years ( EMCDDA, 2021 ).…”