학술논문
State guidance and system changes related to COVID-19: Impact on opioid treatment programs.
Document Type
Academic Journal
Author
Fuller DB; National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America. Electronic address: dfuller@nasadad.org.; Gryczynski J; Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America. Electronic address: jgryczynski@friendsresearch.org.; Schwartz RP; Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America. Electronic address: rschwartz@friendsresearch.org.; Halsted C; National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America. Electronic address: chalsted@nasadad.org.; Mitchell SG; Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America. Electronic address: smitchell@friendsresearch.org.; Whitter M; National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America. Electronic address: mwhitter@nasadad.org.
Source
Publisher: Elsevier Inc Country of Publication: United States NLM ID: 9918541186406676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2949-8759 (Electronic) Linking ISSN: 29498759 NLM ISO Abbreviation: J Subst Use Addict Treat Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: In the United States, methadone treatment may only be provided through opioid treatment programs (OTPs), which operate under a complex system of federal and state regulations. During the pandemic, federal regulators relaxed several longstanding restrictions for OTPs by permitting expanded eligibility for take-home medication and allowing counseling and medication management through telehealth. The purpose of this study was to assess the guidance provided by states regarding the revised guidelines and efforts to protect staff and patients in response to the pandemic.
Methods: Between September and October of 2020, The National Association of State Alcohol and Drug Abuse Directors (NASADAD) and Friends Research Institute, fielded a web-based qualitative survey of state opioid treatment authorities (SOTAs) across the United States, the District of Columbia, and Puerto Rico. The study conducted the survey prior to the availability of the COVID vaccines. It queried 42 SOTAs concerning state guidance provided to OTPs on treatment operations and practices for existing patients and new admissions; actions to protect staff and patients; changes in treatment need and operational capacity; and administrative practices regarding treatment. This study examines the responses of 42 SOTAs (65 %) who completed the survey.
Results: Using content analysis, responses to the survey indicate that most states provided guidance to OTPs in response to the revised federal regulations and the need to protect staff and patients. All respondents reported that their states permitted increased number of take-homes doses for existing patients (100 %) and most reported doing so for new admissions (69 %; N=29). Ninety-eight percent (98 %; N=41) reported permitting remote counseling for existing patients and 90 % (N=38) permitting this for new admissions. SOTAs reported providing guidance on staff safety, operational procedures, oversight, and reforming billing practices to align with new models of service delivery.
Conclusions: SOTAs generally reported that federal guidance increased patient access, engagement, and retention. Increased take-home flexibilities were viewed as important for expanding access and continuity of treatment, with the majority of SOTAs stating that the revised treatment practices (e.g., expansion of telehealth, flexible medication dispensing practices) were beneficial. These regulatory flexibilities, many believe, promoted the continuation of treatment and successful patient outcomes during the pandemic.
Competing Interests: Declaration of competing interest Dr. Schwartz has provided consultation to Verily Life Sciences and Dr. Gryczynski reports part ownership of COG Analytics and receipt of a research grant from Indivior. Both have reported serving as PI on a NIDA grant that was provided medication in-kind by Indivior and Alkermes. All other authors report no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Methods: Between September and October of 2020, The National Association of State Alcohol and Drug Abuse Directors (NASADAD) and Friends Research Institute, fielded a web-based qualitative survey of state opioid treatment authorities (SOTAs) across the United States, the District of Columbia, and Puerto Rico. The study conducted the survey prior to the availability of the COVID vaccines. It queried 42 SOTAs concerning state guidance provided to OTPs on treatment operations and practices for existing patients and new admissions; actions to protect staff and patients; changes in treatment need and operational capacity; and administrative practices regarding treatment. This study examines the responses of 42 SOTAs (65 %) who completed the survey.
Results: Using content analysis, responses to the survey indicate that most states provided guidance to OTPs in response to the revised federal regulations and the need to protect staff and patients. All respondents reported that their states permitted increased number of take-homes doses for existing patients (100 %) and most reported doing so for new admissions (69 %; N=29). Ninety-eight percent (98 %; N=41) reported permitting remote counseling for existing patients and 90 % (N=38) permitting this for new admissions. SOTAs reported providing guidance on staff safety, operational procedures, oversight, and reforming billing practices to align with new models of service delivery.
Conclusions: SOTAs generally reported that federal guidance increased patient access, engagement, and retention. Increased take-home flexibilities were viewed as important for expanding access and continuity of treatment, with the majority of SOTAs stating that the revised treatment practices (e.g., expansion of telehealth, flexible medication dispensing practices) were beneficial. These regulatory flexibilities, many believe, promoted the continuation of treatment and successful patient outcomes during the pandemic.
Competing Interests: Declaration of competing interest Dr. Schwartz has provided consultation to Verily Life Sciences and Dr. Gryczynski reports part ownership of COG Analytics and receipt of a research grant from Indivior. Both have reported serving as PI on a NIDA grant that was provided medication in-kind by Indivior and Alkermes. All other authors report no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)