Responding to health policy recommendations on managing opioid use disorder during Russia's invasion of Ukraine: Divergent responses from the frontline to the west

Abstract

Summary: Russia's invasion of Ukraine on February 24, 2022, followed by Ukraine's Martial law, has disrupted the routine delivery of healthcare services, including opioid agonist treatment (OAT) programs. Directors (chief addiction treatment physicians) of these programs in each region had flexibility with implementing a series of adaptations to their practice to respond to war disruptions like mass internal displacement and legislation updates allowing more flexibility with OAT distribution policies and take-home dosing regulations. We conducted 8 in-depth interviews with directors from seven regions of Ukraine to describe their experiences providing OAT during a specific time during the war and the local crisis-response approach under the emergency policy updates. We categorized their experiences according to the level of exposure to conflict in each region and displacement of patients across the country, which may provide future guidance for OAT provision during the conflict.

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

“…Since the war, the need to operate with insufficient resources increased yet became in some sense more palatable to clinicians who felt they were thus expressing solidarity with their countrymen and contributing to a larger public good. As reflected in recent literature ( 1 ), Ministry of Health relaxed its rigid rules on take-home doses, allowing Ukrainian addiction treatment providers greater flexibility in providing care to patients, allowing expanded take home dosing (from a 10- to a 30-day supply) in order to continue care and minimize loss of patients. Risk of diversion remained.…”

“…Clinicians also addressed the need for their patients to access distant site locations during the war, following abrupt interruption of medication and service delivery after reduced access to local pharmacies and closure of 16 OAT program sites in first month. They managed it by relocating to the Western region and communicated via Telegram-SMS to patients and their network of OAT providers ( 1 ). Yet, it signified the increased risk of patient loss/retention and continuity of care.…”

“…Yet, working beyond human capacity may come at great personal cost, and anecdotal evidence during the crisis shared in recent consultations by our informants from the addiction care in Ukraine suggests that overtime, medical staff may experience negative health outcomes despite their heroic tenacity, with some clinicians physically collapsing at workplace, yet others suffering from burnout. Alongside our own studies during the pandemic and during the subsequent war to unpack responses in addiction care ( 5 ), research suggests possible ways to assist and support providers during the crisis ( 1 , 15 , 40 , 41 ) and maintain their professional well-being by adopting educational interventions through communication platforms like the Network for Improvement of Addiction Treatment (NIATx) model for behavioral health ( 36 ). According to Ivasiy et al ( 1 ), participating in collaborative learning interventions with NIATx coaches, helps to alleviate healthcare workers’ isolation during the crisis ( 1 , 37 ).…”

“…Alongside our own studies during the pandemic and during the subsequent war to unpack responses in addiction care ( 5 ), research suggests possible ways to assist and support providers during the crisis ( 1 , 15 , 40 , 41 ) and maintain their professional well-being by adopting educational interventions through communication platforms like the Network for Improvement of Addiction Treatment (NIATx) model for behavioral health ( 36 ). According to Ivasiy et al ( 1 ), participating in collaborative learning interventions with NIATx coaches, helps to alleviate healthcare workers’ isolation during the crisis ( 1 , 37 ).…”

“…Russia’s attack on Ukraine resulted in displacement of approximately one-third of the population. Displacement had an immediate impact on OAT patients who relied on local pharmacies and OAT programs for daily dosing ( 1 ). In a desperate attempt to minimize the abrupt interruption of medication, OAT providers sent Telegram-SMS messages to patients offering to meet them in designated areas to personally deliver take-home doses.…”