COVID-19 Pandemic Hindered Patient Access to Opioid Treatment Programs

Disruptions in care during the COVID-19 pandemic caused decreased patient access to opioid treatment program services for those with opioid use disorder (OUD), according to research published in JAMA Health Forum.

Opioid-involved overdose mortality rates reached a record high of 69,710 during the COVID-19 pandemic in 2020.

At the onset of the pandemic, many physicians restricted in-person care appointments, and many patients avoided or delayed in-person care. Researchers posited these factors impacted patient access to essential OUD treatment, including buprenorphine possession, urine drug testing, and opioid treatment program services.

To uncover patient access barriers created by the COVID-19 public health emergency, researchers examined trends in opioid use treatment of 6,453 Medicaid beneficiaries with opioid use disorder in Wisconsin between December 2018 and September 2020.

The study findings suggested that the COVID-19 public health emergency did not impact buprenorphine possession, a key drug in medication-assisted treatment.

“Prior to the pandemic, federal regulations required an in-person examination to initiate receipt of controlled substances,” the researcher said in the study. “After the public health emergency  declaration, federal officials temporarily modified these regulations to allow initial and ongoing prescribing of controlled substances, including buprenorphine, via telemedicine or telephone visit.”

“In light of these regulatory changes, maintained rates of buprenorphine possession may represent rapid expansion of telehealth services to enhance access for patients seeking care in office-based settings,” researchers added.

However, patients with OUD could not maintain access to opioid treatment program services during the pandemic. The average rate of patients receiving opioid treatment program services declined by more than 14 percent, from 0.34 per 100,000 patients before the pandemic to 0.29 per 100,000 patients early in the pandemic.

Researchers said there are significant implications restricted care access can have for patients living with OUD. For example, the period following discontinuation of methadone or buprenorphine can result in opioid overdose mortality.

In addition, the weekly average of patients receiving urine drug screens was 0.11 per 100,000. Earlier in the pandemic, researchers found a decline of more than 35 percent in urine drug screening rates (UDT), and these rates were only partially recovered to pre-pandemic levels.

“These trends reflect recommendations from professional organizations like the American Society of Addiction Medicine to suspend routine UDT during the pandemic to minimize exposure risk for patients,” the researchers stated.  “Notably, urine drug testing has long held a central role in the standard treatment of substance use disorders.”

Limited access to opioid treatment programs affects some patients more than others. A study conducted by researchers at NYU School of Global Public Health found that communities with more people of color are less likely to have access to hospital-based opioid use programs.

Hospital adoption of various OUD services was associated with the percentage of Black or Hispanic individuals residing within the communities. Hospitals with a high percentage of Black or Hispanic residents were less likely to offer standard hospital-based programs that increase access to hospital-based treatment services, improve prescribing practices, target-risk education, focus on harm reduction, and address opioid use through community coalitions.

In addition, Back communities also face higher opioid mortality rates caused by the combined use of opioids and stimulant drugs. In a separate study, researchers noticed that the cocaine and opioid overdose death rate was 0.49 per 100,000 people for non-Hispanic White individuals, 0.60 for non-Hispanic Black individuals, 0.14 for Hispanics, and 0.03 for Asian Americans and Pacific Islanders.

Furthermore, the overdoses mortality rate for Black Americans dying from opioids and cocaine increased by 575 percent between 2007 and 2019.  However, White Americans experienced a 184 percent increase within that same time frame.

Researchers urged policymakers to bolster patient access to opioid treatment, especially in communities with a significant minority population.