Unprecedented need and recommendations for harnessing data to guide future policy and practice for opioid use disorder treatment following COVID-19

Abstract

The COVID-19 pandemic struck in the midst of an ongoing opioid epidemic. To offset disruption to life-saving treatment for opioid use disorder (OUD), several federal agencies granted exemptions to existing federal regulations. This included loosening restrictions on medications for OUD (MOUD), including methadone and buprenorphine. In this commentary, we briefly review policy and practice guidelines for treating OUD prior to the onset of the COVID-19 pandemic. We then outline specific MOUD treatment policy and practice exemptions that went into effect in February and March 2020, and discuss the ways in which these unprecedented changes have dramatically changed MOUD treatment. Given the unprecedented nature of these changes, and unknown outcomes to date, we advocate for a data-driven approach to guide future policy and practice recommendations regarding MOUD. We outline several critical clinical, research, and policy questions that can inform MOUD treatment in a post-COVID-19 era.

Did drug use increase following COVID-19 relaxation of methadone take-out regulations? 2020 was a complicated year

“…The unprecedented change in OTP regulations during the COVID-19 pandemic provides a unique opportunity for research and, potentially, regulatory reform (Hatch-Maillette et al, 2020;Livingston et al, 2020). Consistent with other reports (Morin et al, 2021), we found that the absolute percent of positive opioid and non-opioid drug tests increased following the federal variance that allowed more methadone take-out doses, but we also found that this result cannot be fully attributed to alterations in the take-out schedule.…”

Telehealth-Based Delivery of Medication-Assisted Treatment for Opioid Use Disorder: a Critical Review of Recent Developments

“…These included the Drug Addiction Treatment Act of 2000, Title 42 of the Code of Federal Regulations Part 8 (42 CFR 8) for OTPs, and the Federal Ryan Haight Online Pharmacy Consumer Protection Act of 2008. These regulations restricted prescribing and dispensing controlled substances for tele-MOUD and included requirements for in-person encounters to prescribe MOUD [ 49 ]. In addition, reimbursement restrictions and variations across public and private payers created significant complexities.…”

Trends in Use of Telehealth for Behavioral Health Care During the COVID-19 Pandemic: Considerations for Payers and Employers

“…In particular, questions remain about the relationship between the continuation or expansion of these PHE flexibilities, telehealth service use trends, and effective treatment for individuals with OUD. 21 The findings from this analysis make a compelling argument that flexibilities in the workplace should be matched by flexibilities in the delivery of health care via telehealth, although the potential for subsequently creating new barriers to treatment should be carefully considered. On one hand, as workplaces continue to support hybrid working environments, 22 including a broader geographic range of behavioral health providers in employer-based insurance plans via telehealth may be an important strategy to expand employees' access to behavioral health services, especially given current constraints in the behavioral health provider workforce.…”