Two Studies Describe Differences in OTP Responses to COVID-19: What Can We Learn?

In these web pages of Addiction Treatment Forum we feature two research studies describing experiences at opioid treatment programs (OTPs) during COVID-19. The very first research, from Bronx/Montefiore OTPs, reports positive outcomes as well as more-flexible person treatment, compared to pre-COVID. The 2nd research, from RAND Drug Policy Research Center, is based on telephone surveys of caretakers at 20 OTPs in 13 U.S. states, and reports on reactions to service distribution modifications early in the pandemic.

Looking for remarks regarding what we can gain from these researches, we got to out by e-mail to an author of each research study as well as to a leading expert on opioid dependency disorders that was not included in either research:

  • Sarah Hunter, PhD, lead writer of the RAND research study, is a senior behavior researcher, professor at the Pardee RAND Graduate School, and also a participant of the editorial board of the Journal of Substance Abuse TreatmentKristine Torres-Lockhart, MD, second writer of the Bronx/Montefiore study, is an assistant teacher of medication, Division of General Internal Medicine, Montefiore Medical Center & & Albert Einstein College of Medicine
  • Keith Humphreys, PhD, is the Esther Ting Memorial Professor in the Department of Psychiatry as well as Behavioral Sciences at Stanford University, and a trailblazer in avoiding and dealing with dependency disorders

Their comments:

Dr. Torres-Lockhart (Bronx/Montefiore Study)

Kristine Torres-Lockhart, MD, commented that “the loosening of government policies around methadone dispensing as well as professional method during the COVID-19 pandemic has resulted in heterogenous fostering of brand-new practice patterns across the nation. These brand-new practice patterns,” she stated, “seem certain to OTPs.

“OTPs are rooted in a jail system that can be extremely vindictive as well as steeped in structural bigotry, focused in city areas with higher populaces of Black locals,” she noted, while access to buprenorphine is segregated to areas with higher White populaces.

“The RAND study highlights how variable the adoption of clinical method changes was across OTP suppliers, as well as their experiences giving methadone treatment during the pandemic. This study,” she claimed, referring to the Bronx/Montefiore research study, “highlights the value of examining the counterpart, the individual experience and meaningful patient results, given method pattern changes, in a strenuous method. This can offer details to help shape plan changes going forward.

“Current methadone regulations are archaic,” Dr. Torres-Lockhart stated, “and also this is an opportunity to research just how radical modifications to scientific method– raised person flexibility, raised take-home dosages, reduced toxicology testing– can affect meaningful client outcomes (outside of toxicology testing outcomes). It is a chance to better understand exactly how overdose prices, therapy interaction, household engagement, quality of life, etc., transformed with enhanced adaptability, telemedicine, and also increased accessibility to take-home dosages.

“Before the public wellness emergency created by COVID,” she kept in mind, “methadone guidelines were too inflexible and were misaligned with many individual goals for therapy. We currently have a possibility to inform future policy based on rigorous research as well as proof.”

Dr. Hunter (RAND Study)

Dr. Hunter sees the Bronx/Montefiore paper as “a ‘deep dive’ right into one system’s strategy to providing methadone during the COVID pandemic.” Her research, the RAND Study, surveyed prescribers at 20 OTPs “early in the pandemic– last May-June 2020– when a great deal of OTPs were just finding out just how to adapt to the brand-new adaptabilities in recommending, while providing socially remote treatment.”

Dr. Hunter noted that the Bronx/Montefiore research study reported making changes in care-delivery that resembled those of several of the OTPs that RAND surveyed,” such as less constant toxicology screens, however that the Bronx/Montefiore research study also analyzed client results, “which is very valuable and beyond the range of our research study.”

Although the suggestions in the 2 research studies are similar in terms of taking into consideration different compensation strategies, such as permitting more telecare sees and take-home doses, Dr. Hunter mentioned the essential distinction: the Bronx/Montefiore research goes further. The scientists were able additionally to analyze outcomes associated with modifications in monitoring techniques. “That is a wonderful advancement in reasoning, and also to the area,” she claimed.

She added: “Some OTP companies we talked with were rather resistant to any type of modifications in service arrangement (due to the versatilities allowable throughout the pandemic), which talks a bit concerning the variant in point of views amongst OTP providers across the country.

“Bronx/Montefiore is most likely a little bit in advance of the contour in this regard!” she claimed.

Dr. Humphreys

Dr. Humphreys’ remarks reflect his wide viewpoint, created during years in the addiction therapy area.

Dr. Humphreys observed that “decades of global experience with opioid agonist treatment shows that both extremely inflexible and also excessively lax law can damage people and also areas. It’s not surprising,” he claimed, “that clinicians disagree concerning the results of the relaxing of policies COVID caused, since some centers and some clients benefitted, as well as others did not. The most effective way to settle the disagreement is to carry out cautious analyses without prejudgment, so that we can discover what subset of adjustments we intend to keep after COVID is behind us.”

Recommendations

Joseph G, Torres-Lockhart K, Stein MR, Mund PA, Nahvi S. Reimagining patient-centered treatment in opioid therapy programs: Lessons from the Bronx throughout COVID-19. J Subst Abuse Treat. 2021; 122:108219. doi:10.1016/ j.jsat.2020.108219

https://pubmed.ncbi.nlm.nih.gov/33353790/

Hunter SB, Dopp AR, Ober AJ, Uscher-Pines L. Clinician viewpoints on methadone service distribution and using telemedicine throughout the COVID-19 pandemic: A qualitative study. J Subst Abuse Treat. 2021; 124:108288. doi:10.1016/ j.jsat.2021.108288

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833320/

Articles in Addiction Treatment Forum

Reimagining Patient Care: Bronx OTPs Share Lessons Learned During COVID-19. Dependency Treatment Forum, April 27, 2021. By Barbara Goodheart, ELS.

OTP Clinicians’ Responses to Telemedicine as well as Changes in Methadone Service Delivery During COVID-19: A Qualitative Study. Addiction Treatment Forum, May 26, 2021. By Barbara Goodheart, ELS.

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