“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Impacts of the COVID-19 pandemic on enrollment in medications for opioid use disorder (MOUD) in Vancouver, Canada: An interrupted time series analysis

“…Collectively, results from this and prior studies have important clinical and policy implications. Specifically, findings that increased flexibility in MOUD provision during the COVID-19 pandemic was not associated with worse retention outcomes, alongside patients’ self-reported positive experiences ( Conway et al., 2023 ; Krawczyk et al., 2023 ; Scott et al., 2023 ), provide support to consider more permanently implementing a more flexible approach to MOUD provision. As we work towards a more-patient centered system of OUD care, ensuring equitable access to these new flexibilities would be crucial.…”

“…While our analysis does not allow us to disentangle the individual effects of each measure, studies in other Canadian provinces and elsewhere internationally have found that increased take-home dosing was associated with reduced likelihood of discontinuation of MOUD during the COVID-19 pandemic ( Garg et al., 2022 ; Gomes et al., 2022 ; Krawczyk et al., 2023 ; Meteliuk et al., 2021 ; Trayner et al., 2022 ), suggesting that this particular measure may have also had an important impact on facilitating retention in MOUD in our sample. Indeed, patients often cite methadone restrictive take-home dose policies as one of the primary reasons for treatment discontinuation ( Frank et al., 2021 ), and how relaxation to these policies following the COVID-19 pandemic have made their treatment experience more positive, by reducing treatment burden and improving their autonomy and overall quality of life ( Conway et al., 2023 ; Krawczyk et al., 2023 ; Scott et al., 2023 ).…”

Socioeconomic consequences of the COVID‐19 pandemic for people who use drugs

“…Although inflated illicit drug prices (an unintended consequence of pandemic mitigation measures) enabled some participants to reduce their drug use, painful withdrawal and financial and emotional stress were commonplace, including for some, fears they would be forced to commit crime to purchase drugs. Therefore, a commitment from governments to invest in initiatives that increase access to drug treatment and harm reduction programmes (Conway et al, 2023; Dunlop et al, 2020) and responses that address stigma (Sutherland et al, 2023; Treloar et al, 2022) is also needed.…”

“…Forced isolation during lockdowns exacerbated preexisting mental health issues, with many community programmes (e.g. drop‐in centres, supported accommodation services and community meals) closed during lockdowns, (Conway et al, 2023) a factor that created additional stress and encouraged drug use among participants. More than a third ( n = 29) described using more drugs than usual during lockdowns; fifteen of these participants said they had used some of the supplementary payments for this purpose.…”

“…telehealth services replaced in‐person service contact and outreach) disadvantaged some people who preferred face‐to‐face contact or had limited access to digital technology, whereas for others these altered service responses were preferred (Coleman et al, 2022; Searby & Burr, 2021). Similarly, policy changes during the pandemic that increased access to unsupervised opioid agonist treatment takeaway doses produced both positive and negative consequences for people who use opioids (Conway et al, 2023; Dunlop et al, 2020) On the contrary, the reduced capacity of drug treatment services to take on new clients impacted people who use drugs adversely (Dunlop et al, 2020). While these studies provide valuable insights about the impacts of the pandemic and associated responses on people who use illicit drugs, they have not been used to determine the impacts of these complex intersecting factors on their socioeconomic well‐being, including potential sustained impacts beyond the pandemic.…”