Treatment Disruption and Childcare Responsibility as Risk Factors for Drug and Alcohol Use in Persons in Treatment for Substance Use Disorders During the COVID-19 Crisis

Huhn, Andrew S.; Strain, Eric C.; Jardot, Jasmyne; Turner, Gavin; Bergeria, Cecilia L.; Nayak, Sandeep; Dunn, Kelly E.

doi:10.1097/adm.0000000000000813

Cited by 12 publications

(12 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with other reports of disruptions to treatment services by individuals with substance use disorder during COVID-19. 33 Our results suggest that previous studies overestimate methadone availability when all clinics are assumed to accept new patients. 34 , 35 , 36 , 37 Importantly, people using public treatment directories to initiate methadone during the study period had approximately a 1 in 5 chance of engaging with a clinic not accepting new patients and innovations are needed to improve the quality of methadone service information.…”

Section: Discussionmentioning

confidence: 59%

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. OBJECTIVE To compare timely access to methadone initiation in the US and Canada during COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. EXPOSURES Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). MAIN OUTCOMES AND MEASURES Proportion of clinics accepting new patients and days to first appointment. RESULTS Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%)during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001).Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.

show abstract

Section: Discussionmentioning

confidence: 59%

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Health‐care costs were restricted to hospitalization costs, hence missing outpatient, pharmacy and other health‐care costs. We did not account for decreases in elective health care utilization and disruptions to behavioral health treatment in the early phases of the pandemic [ 64 , 65 ]. Delays in obtaining care for alcohol‐related conditions can exacerbate the risk of downstream hospitalizations and premature mortality, and the inaccessibility to behavioral health‐care may result in a higher prevalence of AUD.…”

Section: Discussionmentioning

confidence: 99%

“…Health-care costs were restricted to hospitalization costs, hence missing outpatient, pharmacy and other health-care costs. We did not account for decreases in elective health care utilization and disruptions to behavioral health treatment in the early phases of the pandemic [64,65].…”

Section: Discussionmentioning

confidence: 99%

Modeling the impact of COVID‐19 pandemic‐driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States

et al. 2022

View full text Add to dashboard Cite

Background and aims Alcohol consumption increased in the early phases of the COVID‐19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID‐19 pandemic. Design An individual‐level simulation model of the long‐term drinking patterns for people with life‐time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life‐time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year (‘increase‐1’) and (3) increased drinking levels persist for 5 years (‘increase‐5’). Setting United States. Participants Current drinkers with life‐time AUD. Measurements Life expectancy [life‐years (LYs)], quality‐adjusted life‐years (QALYs), alcohol‐related hospitalizations and associated hospitalization costs and alcohol‐related deaths, during a 5‐year period. Findings Short‐term increases in alcohol consumption (increase‐1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000–201 000] LYs, a loss of 332 000 (104 000–604 000) QALYs and 295 000 (82 000–501 000) more alcohol‐related hospitalizations, costing an additional $5.4 billion ($1.5–9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9–4.8 billion) in hospitalization costs, more than half the increase across all alcohol‐related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non‐Hispanic black individuals. Increasing the duration of pandemic‐driven increases in alcohol consumption in the increase‐5 scenario resulted in larger impacts. Conclusions Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol‐related mortality, morbidity and associated costs will increase substantially over the next 5 years.

show abstract

“…However, these changes to usual practice came with some drawbacks. Service disruptions and unmet support needs have been recorded as a direct result of the impact of the COVID-19 pandemic [ 36 , 38 , 39 ]. Such initial lack of adequate provision of care is not exclusive to the substance and alcohol misuse field, with early reports from mental health patients in China experiencing difficulties accessing general mental health services and support [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and substance use disorders: a review of international guidelines for frontline healthcare workers of addiction services

et al. 2022

View full text Add to dashboard Cite

Background People with substance use disorders may be at a greater risk of contracting COVID-19 infection and developing medical complications. Several institutional and governmental health agencies across the world developed ad hoc guidance for substance use disorder services and care of individuals misusing substances. We aimed to synthesise the best available recommendations on management and care of people with or at risk of substance use disorders during the COVID-19 pandemic from existing guidelines published in UK, USA, Australia, Canada, New Zealand, and Singapore. Methods We systematically searched existing guidelines and websites from 28 international institutions and governmental bodies in the context of the COVID-19 pandemic (May 4th 2021). We summarized the extracted data as answers to specific clinical questions. Results We organised the available recommendations from 19 sources in three sections. First, we focused on general advice and recommendations for people who misuse alcohol or drugs during the COVID-19 pandemic, the design of contingency plans, safeguarding issues for children and families of service users and advice to the public, patients, and carers. Then, we summarised specific guidelines for people who use illicit drugs and related services, such as opioid substitution treatment and needle and syringe programmes. Finally, we provided a synthesis on specific recommendations for services supporting people who misuse alcohol and key topics in the field, such as management of alcohol detoxification and safe transition between supervised and unsupervised consumption. Conclusions Available guidance reflected different approaches, ranging from being extremely cautious in providing recommendations other than generic statements to proposing adaptation of previously available guidelines to confront the challenges of the COVID-19 pandemic. After the early phase, guidance focused on reduction of infection transmission and service delivery. Guidance did not provide advice on infection prevention via vaccination programmes and service access strategies tailored to individuals with substance use disorders.

show abstract

Treatment Disruption and Childcare Responsibility as Risk Factors for Drug and Alcohol Use in Persons in Treatment for Substance Use Disorders During the COVID-19 Crisis

Cited by 12 publications

References 39 publications

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada

Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada

Modeling the impact of COVID‐19 pandemic‐driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States

COVID-19 and substance use disorders: a review of international guidelines for frontline healthcare workers of addiction services

Contact Info

Product

Resources

About