Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

Addiction Science & Clinical Practice - Tập 16 Số 1 - 2021
Noa Krawczyk1, Adetayo Fawole2, Jenny Yang3, Babak Tofighi4
1Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 4-12, New York, NY, USA
2New York University, School of Global Public Health, New York, NY, USA
3NYU Grossman School of Medicine, New York, NY, USA
4Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA

Tóm tắt

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

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Tài liệu tham khảo

Medical Association A. Issue brief: Reports of increases in opioid-related overdose and other concerns during COVID pandemic [Internet]. 2020. https://chicago.suntimes.com/2020/5/13/21257820/dupage-opioid-overdose-death. Accessed 1 June 2020.

The Ontario Drug Policy Research Network, The Office of the Chief Coroner for Ontario/Ontario Forensic Pathology Service, Public Health Ontario, Centre on Drug Policy Evaluation. Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic. 2020;(November):1–24. https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en. Accessed 14 Feb 2021.

British Columbia Centre for Disease Control. Illegal Drug Overdose Events [Internet]. Overdose Response Reports. 2020. p. 1. http://www.bccdc.ca/health-professionals/data-reports/illegal-drug-overdose-events. Accessed 14 Feb 2021.

Manthey J, Kilian C, Dresden TU, Carr S, Bloomeld K, Braddick F, et al. Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European Substance Users. 2021 Jan 22. https://doi.org/10.21203/rs.3.rs-150691/v1. Accessed 14 Feb 2021.

Cowan E, Khan MR, Shastry S, Edelman EJ. Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: an application of the social ecological model [Internet]. Vol. 16, Addiction Science and Clinical Practice. BioMed Central Ltd; 2021. p. 4. https://ascpjournal.biomedcentral.com/articles/https://doi.org/10.1186/s13722-020-00210-w. Accessed 3 Feb 2021.

Haley DF, Saitz R. The opioid epidemic during the COVID-19 pandemic. JAMA [Internet]. 2020. https://jamanetwork.com/journals/jama/fullarticle/2770985. Accessed 23 Sept 2020.

Wakeman SE, Green TC, Rich J. An overdose surge will compound the COVID-19 pandemic if urgent action is not taken. Nat Med. 2020;1–2. http://www.nature.com/articles/s41591-020-0898-0. Accessed 19 May 2020.

Alexander GC, Stoller KB, Haffajee RL, Saloner B. An epidemic in the midst of a pandemic: opioid use disorder and COVID-19. Ann Intern Med [Internet]. 2020. http://www.ncbi.nlm.nih.gov/pubmed/32240283. Accessed 8 Apr 2020.

Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Mol Psychiatry [Internet]. 2020;1–10. http://www.nature.com/articles/s41380-020-00880-7. Accessed 18 Sept 2020.

Allen B, El Shahawy O, Rogers E, Hochman S, Khan M, Krawczyk N. Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020. J Public Health (Bangkok) [Internet]. 2020. https://pubmed.ncbi.nlm.nih.gov/33367823/. Accessed 29 Dec 2020.

Krawczyk N, Mojtabai R, Stuart E, Fingerhood M, Agus D, Lyons BC, et al. Opioid agonist treatment and fatal overdose risk in a statewide population receiving opioid use disorder services. Addiction. 2020.

Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.

Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23(2):63–75.

McDonald R, Campbell ND, Strang J. Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—conception and maturation. Vol. 178, Drug and Alcohol Dependence. Elsevier Ireland Ltd; 2017. p. 176–87.

Saloner B, McGinty EE, Beletsky L, Bluthenthal R, Beyrer C, Botticelli M, et al. A public health strategy for the opioid crisis. Public Health Rep. 2018;133(1_suppl):24S-34S. https://doi.org/10.1177/0033354918793627.

Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, et al. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med. 2019;16(11):e1002969. https://doi.org/10.1371/journal.pmed.1002969.

Krawczyk N, Fingerhood MI, Agus D. Lessons from COVID 19: are we finally ready to make opioid treatment accessible? J Subst Abuse Treat. 2020. https://doi.org/10.1016/j.jsat.2020.108074.

Dunlop A, Lokuge B, Masters D, Sequeira M, Saul P, Dunlop G, et al. Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J. 2020. https://doi.org/10.1186/s12954-020-00370-7.

Krawczyk N, Bunting AM, Frank D, Arshonsky J, Gu Y, Friedman SR, et al. “How will I get my next week’s script?” Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic. Int J Drug Policy. 2021;92:103140.

Substance Abuse and Mental Health Services Administration. FAQs: provision of methadone and buprenorphine for the treatment of Opioid Use Disorder in the COVID-19. 2020;5–7. https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf. Accessed 9 Sept 2020.

Ahamad K, Bach P, Brar R, Chow N, Coll N, Compton M, et al. Risk mitigation in the context of dual public health emergencies: interim clinical guidance [Internet]. 2020. http://bcyadws.ca/sites/default/files/2020-04/Risk-Mitigation-in-the-Context-of-Dual-Public-Health-Emergencies.pdf. Accessed 14 Sept 2021.

Nosyk B, Slaunwhite A, Urbanoski K, Hongdilokkul N, Palis H, Lock K, et al. Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia: a mixed-method study protocol. BMJ Open [Internet]. 2021;11(6):e048353. https://bmjopen.bmj.com/content/11/6/e048353. Accessed 14 Sept 2021.

Victoria State Government Health and Human Services. Coronavirus (COVID-19) Response Pharmacotherapy services: information for prescribers and dispensers [Internet]. 2020. https://www2.health.vic.gov.au/public-health/drugs-and. Accessed 14 Feb 2021.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467. https://doi.org/10.7326/M18-0850.

Chen Q, Allot A, Lu Z. LitCovid: an open database of COVID-19 literature. Nucleic Acids Res [Internet]. 2021;49(D1):D1534–40. https://academic.oup.com/nar/article-abstract/49/D1/D1534/5964074. Accessed 30 Mar 2021.

Larsen KL, Linares BM. LitCovid: a database of coronavirus research. Med Ref Serv Q. 2021;40(1):103–9.

Kellermeyer L, Harnke B, Knight S. Covidence and rayyan. J Med Libr Assoc. 2018;106(4):580.

Popay J, Arai L, Rodgers M, Britten N. Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC Methods Programme Communities in Control-Big Local Evaluation View project VOICES (ViOlence: Impact on Children Evidence Synthesis) View project. 2006. https://www.researchgate.net/publication/233866356. Accessed 9 Apr 2021.

Crowley D, Delargy I. A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report. Harm Reduct J. 2020;17(1):49. https://doi.org/10.1186/s12954-020-00394-z.

Samuels EA, Clark SA, Wunsch C, Jordison Keeler LA, Reddy N, Vanjani R, et al. Innovation during COVID-19: improving addiction treatment access. J Addict Med. 2020;14(4):e8-9.

Singh LK, Tikka SK. Nondisrupted, safety ensured, opioid substitution clinic in a COVID-19 designated hospital of a resource-limited state in India. Asia Pacific Psychiatry. 2020. https://doi.org/10.1111/appy.12428.

Vecchio S, Ramella R, Drago A, Carraro D, Littlewood R, Somaini L. COVID19 pandemic and people with opioid use disorder: innovation to reduce risk. Psychiatry Res. 2020;289:113047.

Quiñones D, Melin K, Roman L, Rodriguez F, Alvarado J, Rodriguez-Diaz CE. Treating opioid use disorder in puerto rico during the COVID-19 pandemic: providers’ leadership efforts in unprecedented times. J Addict Med [Internet]. 2020. https://europepmc.org/article/med/33229933. Accessed 30 Mar 2021.

Castillo M, Conte B, Hinkes S, Mathew M, Na CJ, Norindr A, et al. Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic. Harm Reduct J. 2020;17(1):88. https://doi.org/10.1186/s12954-020-00438-4.

Tringale R, Subica AM. COVID-19 innovations in medication for addiction treatment at a Skid Row syringe exchange. J Subst Abuse Treat. 2021;121:108181. https://doi.org/10.1016/j.jsat.2020.108181.

Nordeck CD, Buresh M, Krawczyk N, Fingerhood M, Agus D. Adapting a low-threshold buprenorphine program for vulnerable populations during the COVID-19 pandemic. J Addict Med [Internet]. 2020. https://europepmc.org/article/med/33177436. Accessed 30 Mar 2021.

Harris M, Johnson S, Mackin S, Saitz R, Walley AY, Taylor JL. Low barrier tele-buprenorphine in the time of COVID-19: a case report. J Addict Med. 2020;14(4):e136–8.

Duncan A, Sanders N, Schiff M, Winkelman TNA. Adaptations to jail-based buprenorphine treatment during the COVID-19 pandemic. J Subst Abuse Treat. 2021;121:108161.

Komaromy M, Tomanovich M, Taylor JL, Ruiz-Mercado G, Kimmel SD, Bagley SM, et al. Adaptation of a system of treatment for substance use disorders during the COVID-19 pandemic. J Addict Med [Internet]. 2020. https://europepmc.org/article/med/33298750. Accessed 30 Mar 2021.

Hughto JMW, Peterson L, Perry NS, Donoyan A, Mimiaga MJ, Nelson KM, et al. The provision of counseling to patients receiving medications for opioid use disorder: telehealth innovations and challenges in the age of COVID-19. J Subst Abuse Treat. 2021;120:108163.

McKiever ME, Cleary EM, Schmauder T, Talley A, Hinely KA, Costantine MM, et al. Unintended consequences of the transition to telehealth for pregnancies complicated by opioid use disorder during the coronavirus disease 2019 pandemic. Am J Obstetr Gynecol. 2020;223:770–2.

Courser MW, Raffle H. With crisis comes opportunity: unanticipated benefits resulting from pivots to take-home naloxone (THN) programs during the COVID-19 pandemic. J Subst Abuse Treat. 2021;122:108220.

Peavy KM, Darnton J, Grekin P, Russo M, Green CJB, Merrill JO, et al. Rapid implementation of service delivery changes to mitigate COVID-19 and maintain access to methadone among persons with and at high-risk for HIV in an opioid treatment program. AIDS Behav. 2020;24:2469–72.

MacKinnon L, Socías ME, Bardwell G. COVID-19 and overdose prevention: challenges and opportunities for clinical practice in housing settings. J Subst Abuse Treat. 2020;119:108153.

Basu D, Ghosh A, Subodh B, Mattoo S. Opioid substitution therapy with buprenorphine-naloxone during COVID-19 outbreak in India: sharing our experience and interim standard operating procedure. Indian J Psychiatry. 2020;62(3):322.

Trujols J, Larrabeiti A, Sànchez O, Madrid M, De Andrés S, Duran-Sindreu S. Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: should this practice be incorporated into routine clinical care? J Subst Abuse Treat. 2020;119:108154.

Hazan J, Congdon L, Sathanandan S, Grewal P. An analysis of initial service transformation in response to the COVID-19 pandemic in two inner-city substance misuse services. J Subst Use. 2020. https://doi.org/10.1080/14659891.2020.1820089.

Ghosh A, Singh S, Dutta A. Opioid agonist treatment during SARS-CoV2 & extended lockdown: adaptations & challenges in the Indian context. Asian J Psychiatry. 2020;53:102377.

Straub A, Pastor A, Lloyd-Jones M, O’Neill H, Bonomo Y. The development and implementation of a rapid-access long-acting injectable buprenorphine clinic in metropolitan Melbourne during the COVID-19 pandemic. Drug Alcohol Rev. 2020. https://doi.org/10.1111/dar.13161.

Wenzel K, Fishman M. Mobile van delivery of extended-release buprenorphine and extended-release naltrexone for youth with OUD: an adaptation to the COVID-19 emergency. J Subst Abuse Treat. 2021;120:108149.

Roberts J, White B, Attalla D, Ward S, Dunlop AJ. Rapid upscale of depot buprenorphine (CAM2038) in custodial settings during the early COVID-19 pandemic in New South Wales, Australia. Addiction. 2021;116:426–7.

Warrington JS, Brett A, Foster H, Brandon J, Francis-Fath S, Joseph M, et al. Driving access to care: use of mobile units for urine specimen collection during the coronavirus disease-19 (COVID-19) pandemic. Acad Pathol. 2020. https://doi.org/10.1177/2374289520953557.

Harris MTH, Peterkin A, Bach P, Englander H, Lapidus E, Rolley T, et al. Adapting inpatient addiction medicine consult services during the COVID-19 pandemic. Addict Sci Clin Pract. 2021. https://doi.org/10.1186/s13722-021-00221-1.

Marcus TS, Heese J, Scheibe A, Shelly S, Lalla SX, Hugo JF. Harm reduction in an emergency response to homelessness during South Africa’s COVID-19 lockdown. Harm Reduct J. 2020;17(1):60. https://doi.org/10.1186/s12954-020-00404-0.

Joudrey PJ, Edelman EJ, Wang EA. Drive times to opioid treatment programs in urban and rural counties in 5 US States [Internet]. Vol. 322, JAMA Journal of the American Medical Association. American Medical Association; 2019, p. 1310–2. https://jamanetwork.com/journals/jama/fullarticle/2752051. Accessed 2 Oct 2019.

Reisinger HS, Schwartz RP, Mitchell SG, Peterson JA, Kelly SM, O’Grady KE, et al. Premature discharge from methadone treatment: patient perspectives. J Psychoactive Drugs. 2009;41(3):285–96. https://doi.org/10.1080/02791072.2009.10400539.

Bourgois P. Disciplining addictions: the bio-politics of methadone and heroin in the United States. Cult Med Psychiatry. 2000;24(2):165–95.

Gryczynski J, Mitchell SG, Jaffe JH, O’Grady KE, Olsen YK, Schwartz RP. Leaving buprenorphine treatment: patients’ reasons for cessation of care. J Subst Abuse Treat. 2014;46(3):356–61.

Kavanaugh PR, McLean K. Motivations for diverted buprenorphine use in a multisite qualitative study. J Drug Issues. 2020. https://doi.org/10.1177/0022042620941796.

Hunter SB, Dopp AR, Ober AJ, Uscher-Pines L. Clinician perspectives on methadone service delivery and the use of telemedicine during the COVID-19 pandemic: a qualitative study. J Subst Abuse Treat [Internet]. 2021, p. 124. https://www.sciencedirect.com/science/article/pii/S0740547221000143. Accessed 16 Feb 2021.

Uscher-Pines L, Sousa J, Raja P, Mehrotra A, Barnett M, Huskamp HA. Treatment of opioid use disorder during COVID-19: experiences of clinicians transitioning to telemedicine. J Subst Abuse Treat [Internet]. 2020;118. https://www.sciencedirect.com/science/article/pii/S0740547220303809?casa_token=1EO-79-U0gYAAAAA:3HjxUDNcHSxoLtFkp6ycxTHXumUZdO3ZKs0NlLZ2N9O-M6BE-VEKIr0c7ubWdms33vJFam4. Accessed 24 Mar 2021.

Doernberg M, Krawczyk N, Agus D, Fingerhood MI. Demystifying buprenorphine misuse: has fear of diversion gotten in the way of addressing the opioid crisis? Subst Abus. 2019. https://doi.org/10.1080/08897077.2019.1572052.

Krawczyk N, Bandara S, Maniates H, Hulsey E, Smith J, DiDomenico E, et al. Assessing changes in opioid treatment program practices and policies in response to COVID-19: a Pennsylvania State-Wide Survey. In: RxSummit. 2021.

Gupta VK, Hansen H, Mendoza S, Chen XL, Swift RG. Merging outpatient addiction and opioid-maintenance programs during a disaster: lessons from hurricane sandy. Disaster Med Public Health Prep. 2017;11(5):531–7. https://doi.org/10.1017/dmp.2016.190.

Cochran G, Bruneau J, Cox N, Gordon AJ. Substance abuse medication treatment for opioid use disorder and community pharmacy: expanding care during a national epidemic and global pandemic. Subst Abus. 2020;41(3):269–74.

Madras BK, Ahmad NJ, Wen J, Sharfstein J. Improving access to evidence-based medical treatment for opioid use disorder: strategies to address key barriers within the treatment system. NAM Perspect. 2020. https://doi.org/10.31478/202004b.

Rutkow L, Vernick JS, Mojtabai R, Rodman SO, Kaufmann CN. Legal challenges for substance abuse treatment during disasters. Psychiatr Serv. 2012;63:7–9.

Lin L, Casteel D, Shigekawa E, Weyrich MS, Roby DH, McMenamin SB. Telemedicine-delivered treatment interventions for substance use disorders: a systematic review. J Subst Abuse Treat. 2019;101:38–49.

Weintraub E, Greenblatt AD, Chang J, Himelhoch S, Welsh C. Expanding access to buprenorphine treatment in rural areas with the use of telemedicine. Am J Addict. 2018;27(8):612–7. https://doi.org/10.1111/ajad.12805.

Cantor JH, McBain RK, Pera MF, Bravata DM, Whaley CM. Who is (and is not) receiving telemedicine care during the COVID-19 pandemic. Am J Prev Med [Internet]. 2021. https://linkinghub.elsevier.com/retrieve/pii/S0749379721001318. Accessed 30 Mar 2021

Tofighi B, McNeely J, Walzer D, Fansiwala K, Demner A, Chaudhury CS, et al. A telemedicine buprenorphine clinic to serve New York City. J Addict Med. 2021. https://doi.org/10.1097/ADM.0000000000000809.

Tofighi B, Leonard N, Greco P, Hadavand A, Acosta MC, Lee JD. Technology use patterns among patients enrolled in inpatient detoxification treatment. J Addict Med. 2019;13(4):279–86.

Davis CS, Carr D. Over the counter naloxone needed to save lives in the United States. Vol. 130, Preventive Medicine. Academic Press Inc.; 2020. p. 105932.

Dunn KE, Yepez-Laubach C, Nuzzo PA, Fingerhood M, Kelly A, Berman S, et al. Randomized controlled trial of a computerized opioid overdose education intervention. Drug Alcohol Depend. 2017;1(173):S39-47.

Bennett AS, Elliott L. Naloxone’s role in the national opioid crisis—past struggles, current efforts, and future opportunities. Transl Res [Internet]. 2021. https://linkinghub.elsevier.com/retrieve/pii/S1931524421000517 Accessed 26 Mar 2021.

Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study. Drug Alcohol Depend. 2020;216:108202.

Tyndall M. Safer opioid distribution in response to the COVID-19 pandemic. Int J Drug Policy. 2020;27:102880.

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