Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine

Abstract

On March 16, 2020, Ukraine's Ministry of Health issued nonspecific interim guidance to continue enrolling patients in opioid agonist therapies (OAT) and transition existing patients to take-home dosing to reduce community COVID-19 transmission. Though the number of OAT patients increased modestly, the proportion receiving take-home dosing increased from 57.5% to 82.2%, which translates on average to 963,952 fewer clinic interactions annually (range: 728,652–1,016,895) and potentially 80,329 (range: 60,721–84,741) fewer hours of in-person clinical encounters. During the transition, narcologists (addiction specialists) expressed concerns about overdoses, the guidance contradicting existing legislation, and patient dropout, either from incarceration or inadequate public transportation. Though clinicians did observe some overdoses, short-term overall mortality remained similar to the previous year. As the country relaxes the interim guidance, we do not know to what extent governmental guidance or clinical practice will change to adopt the new guidance permanently or revert to pre-guidance regulations. Some future considerations that have come from COVID-19 are should dosing schedules continue to be flexible, should clinicians adopt telehealth, and should there be more overdose education and naloxone distribution? OAT delivery has improved and become more efficient, but clinicians should plan long-term should COVID-19 return in the near future. If the new efficiencies are maintained, it will free the workforce to further scale up OAT.

Pathways between COVID-19 public health responses and increasing overdose risks: A rapid review and conceptual framework

“…The experience of quarantining and isolation itself also leads to worsening mental health, increased stress, and feelings of anxiety, despair, and depression, all of which potentiate the risk of relapse and substance use ( Henry et al., 2020 ; Khatri & Perrone, 2020 ; Lapeyre-Mestre et al., 2020 ; MacKinnon et al., 2020 ; Meteliuk et al., 2020 ; Slavova et al., 2020 ; Stack et al., 2020 ; Walters, 2020 ). Vasylyeva et al.…”

Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

“…Given the recognized risk of adverse health outcomes for patients with OUD, and the risks prescribers reported for patients with additional unsupervised doses, all patients on OAT should receive harm reduction counseling and supports. Although risks of adverse outcomes related to OAT are always present, recent evidence from Ukraine and the United States show that despite changes in OAT prescribing practices (i.e., more unsupervised doses prescribed) during the pandemic, overdoses ( Amram et al, 2021 ) or deaths due to OAT have not increased ( Brothers, Viera, & Heimer, 2021 ; Meteliuk et al, 2021 ). The results from our study contribute to a growing body of research that suggests relaxing the criteria for unsupervised doses is not associated with significant negative health outcomes and may be a feasible approach to increasing patient engagement in care.…”

Methadone exposures reported to poison control centers in the United States following the COVID-19-related loosening of federal methadone regulations

“…Several studies looking at the effect of increased take-home doses during the COVID-19 pandemic have reported minimal diversion of methadone and no increases in methadone-related overdoses ( Amram, Amiri, Thorn, Lutz, & Joudrey, 2021 ; Brothers, Viera, & Heimer, 2021 ; Figatt, Salazar, Day, Vincent, & Dasgupta, 2021 ; Joseph, Torres-Lockhart, Stein, Mund, Nahvi, 2021 ; Lavander, Pytell, Stoller, Korthuis, & Chander, 2021 ; Meteliuk et al, 2021 ). Most of the studies thus far have looked at data collected from a single program ( Amram et al, 2021 ) or a group of programs in a single area ( Figgatt et al, 2021 ; Joseph et al, 2021 ) or a single state ( Brothers et al, 2021 ), or other countries ( Meteliuk et al, 2021 ). Others suffer from substantial biases such as reliance almost entirely on patient self-report ( Figgatt et al, 2021 ) or program self-report with low response rates ( Levander et al, 2021 ).…”