Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review

Vargas, Divane de; Pereira, Caroline Figueira; Volpato, Rosa Jacinto; Lima, Ana Vitória Corrêa; Ferreira, Rogério; Oliveira, Sheila Ramos de; Aguilar, Thiago Faustino

doi:10.3390/ijerph182212094

Cited by 13 publications

(11 citation statements)

References 97 publications

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“…In communities around the world, the COVID-19 pandemic laid bare underlying social inequities [40], and as reiterated by our findings, these inequities had notable consequences for the wellbeing of PWUD and their treatment experiences. First, for PWUD experiencing socioeconomic marginalization or unemployment, financial instability can not only jeopardize their material security, but also impact substance use patterns, drug scene involvement, and exposure to overdose risks, criminalization, or violence [41][42][43].…”

Section: Discussionsupporting

confidence: 68%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

et al. 2023

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Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

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Section: Discussionsupporting

confidence: 68%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

et al. 2023

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“…In communities around the world, the COVID-19 pandemic laid bare underlying social inequities [39], and as reiterated by our ndings, these inequities had notable consequences for the wellbeing of PWUD and their treatment experiences. First, for PWUD experiencing socioeconomic marginalization or unemployment, nancial instability can not only jeopardize their material security, but also impact substance use patterns, drug scene involvement, and exposure to overdose risks, criminalization, or violence [40][41][42].…”

Section: Discussionsupporting

confidence: 51%

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

Jaffe

Blawatt

Lehal

et al. 2023

Preprint

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Background Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider-client interaction—treatment components made difficult by the pandemic. Methods Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. Results Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. Conclusion Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment offers, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

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“…In response to the introduction of COVID-19 social distancing measures in March 2020, drug treatment services had to quickly adapt their operating procedures to ensure continuity of care while mitigating risk of viral infection. For patients receiving daily opioid agonist treatment (OAT) for opioid use disorder (OUD), treatment guidelines were relaxed in several countries [1][2][3][4] to allow for more take-home doses of methadone and buprenorphine and decrease requirements for in-person visits and drug screening. This rapid shift to unsupervised dosing has prompted renewed calls for more exible OAT delivery to improve access and reduce burden of treatment for patients [5].…”

Section: Introductionmentioning

confidence: 99%

Flexible delivery of opioid agonist treatment during COVID-19 in Norway: A cross-sectional survey of provider experiences

McDonald

Bech

Clausen

2023

Preprint

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Background and Aims: For patients receiving daily opioid agonist treatment (OAT) for opioid dependence, several countries relaxed treatment guidelines at the beginning of the COVID-19 pandemic. This involved longer take-home intervals for methadone and buprenorphine doses as well as a reduction in supervised dosing and drug screening. To date, little is known about the medium or long-term experience of such OAT deregulation. Therefore, we conducted a survey to explore how OAT providers perceived greater flexibility in OAT service delivery at the end of the second year of the pandemic. Design: Nationwide cross-sectional study. Setting: OAT units in 19 publicly funded hospital trusts in Norway. Participants: Twenty-three (of whom 14 female; 61%) managers or lead physicians of OAT units. Measurements: A 29-item online questionnaire comprising closed-format and open-ended questions covering: treatment provider experiences and changes in OAT service delivery during the past 12 months (January to December 2021). Findings: In 2021, most OAT units (91.3%, n = 21) still practiced some adjusted approaches as established in the beginning of the pandemic. The most common adaptions were special protocols for COVID-19 cases (95.7%, n = 22), increased use of telephone- (91.3%, n= 21) and video consultations (87.0%, n= 20), and longer take-home intervals for OAT medications (52.2%, n = 12). The use of depot buprenorphine also increased substantially during the pandemic. According to the providers, most patients handled flexible treatment provision well. In individual cases, patients’ substance use was identified as key factor necessitating a reintroduction of supervised dosing and drug screening. Collaboration with general practitioners and municipal health and social services was generally perceived as crucial for successful treatment delivery. Conclusions: Overall, the Norwegian OAT system proved resilient in the second year of the COVID-19 pandemic, as its healthcare workforce embraced innovation in technology (telemedicine) and drug development (depot buprenorphine). According to our nationally representative sample of OAT providers, most patients were compliant with longer take-home doses of methadone and buprenorphine. Our findings suggest that telemedicine can be useful as adjunct to face-to-face treatment and provide greater flexibility for patients.

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Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review

Cited by 13 publications

References 97 publications

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

Flexible delivery of opioid agonist treatment during COVID-19 in Norway: A cross-sectional survey of provider experiences

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