Open Access Open Access  Restricted Access Subscription or Fee Access

Review of the adaptations in opioid agonist treatment during the COVID-19 pandemic: Focus on buprenorphine-based treatment

Abhishek Ghosh, MD, DM, Chandrima Naskar, MD, Fazl-e Roub, MD, DM, Debasish Basu, MD, DNB, MAMS

Abstract


Background: Availability and access to opioid agonist treatment (OAT) are limited despite its evidence of effectiveness in treating opioid use disorders (OUDs). COVID-19 pandemic has inadvertently exacerbated the problems of restricted access to OAT and, at the same time, has increased odds of harm due to opioid use.

Objectives: We examined (a) adaptations conceived or implemented in the buprenorphine (BPN)-based OAT service delivery at the national, regional, or local level during the COVID-19 pandemic and (b) the impact of such transformations on the quantitative and qualitative aspects of service delivery. We focused exclusively on BPN-based OAT.

Methods: We carried out a systematic electronic database search in PubMed and Google Scholar. We included all types of articles. Additionally, we looked up relevant websites of international and national government agencies working in the field of drug abuse.

Results: We included 21 articles from 10 countries in the review and summarized the results in a narrative format. The majority of literature was from developed countries. We observed changes in the BPN initiation, dosing, and dispensing protocols, and particular emphasis on telemedicine. There was limited literature on service provisions for the vulnerable population. The changing modes of service delivery have possibly increased the number of new patients and reduced the risk of exposure owing to limited in-person contact.

Conclusion: Newer adaptations to meet with the challenges of COVID-19 pandemic in the BPN-based OAT delivery tend to be innovative, flexible, and patient centered. Although it is too early to comment on these newer adaptations’ impact, the outcome's directions appear to be positive.


Keywords


COVID-19, buprenorphine, opioid agonist treatment, review

Full Text:

PDF

References


J World Health Organization: Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention: WHO/UNODC/UNAIDS position paper. WHO. 2004. Available at https://www.who.int/substance_abuse/publications/en/PositionPaper_English.pdf. Accessed January 10, 2021

Dhawan A, Jhanjee S, eds.: Manual for Long-Term Pharmacotherapy. New Delhi: National Drug Dependence Treatment Centre, AIIMS, 2007. Available at http://dtc-scheme.in/for-professional/manual/Long-term-pharmacotherapymanual.pdf. Accessed January 10, 2021.

Wodak A: Methadone matters: Evolving community methadone treatment of opiate addiction. Addiction. 2004; 99(4): 519-520. DOI: 10.1111/j.1360-0443.2004.00723.x.

Dole VP, Nyswander M: A medical treatment for diacetylmorphine (heroin) addiction: A clinical trial with methadone hydrochloride. JAMA. 1965; 193(8): 646-650. DOI: 10.1001/jama.1965.03090080008002.

Wieneke H, Conrads H, Wolstein J, et al.: Levo-alphaacetylmethadol (LAAM) induced QTc-prolongation—Results from a controlled clinical trial. Eur J Med Res. 2009; 14(1): 7-12. DOI: 10.1186/2047-783x-14-1-7.

Marquet P: Pharmacology of high dose buprenorphine. In Kintz P, Marquet P (eds.): Buprenorphine Therapy of Opiate Addiction. Totowa, NJ: Humana Press, 2002: 1-11.

Shulman M, Wai JM, Nunes EV: Buprenorphine treatment for opioid use disorder: An overview. CNS Drugs. 2019; 33(6): 567-580. DOI: 10.1007/s40263-019-00637-z.

SUBLOCADE [package insert]: Indivior Inc, North Chesterfield, VA 2018.

World Health Organization: WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users—2012 revision. Geneva, Switzerland: World Health Organization. 2012.

Gowing L, Farrell MF, Bornemann R, et al.: Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2011; (8): CD004145. DOI: 10.1002/14651858.CD004145.pub4.

Cornish R, Macleod J, Strang J, et al.: Risk of death during and after opiate substitution treatment in primary care: Prospective observational study in UK general practice research database. BMJ. 2010; 341: C5475-C5475. DOI: 10.1136/bmj.c5475.

Auriacombe M, Fatséas M, Dubernet J, et al.: French field experience with buprenorphine. Am J Addict. 2004; 13 (Suppl. 1): S17-S28. DOI: 10.1080/10550490490440780.

Hser Y-I, Saxon AJ, Huang D, et al.: Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014; 109(1): 79-87. DOI: 10.1111/add.12333.

Hawk KF, D'Onofrio G, Chawarski MC, et al.: Barriers and facilitators to clinician readiness to provide emergency department-initiated buprenorphine. JAMA Netw Open. 2020; 3(5): e204561. DOI: 10.1001/jamanetworkopen.2020.4561.

Lynch T, Clark D, Centeno C, et al.: Barriers to the development of palliative care in the countries of Central and Eastern Europe and the commonwealth of independent states. J Pain Symptom Manage. 2009; 37(3): 305-315. DOI: 10.1016/j.jpainsymman.2008.03.011.

Deering DEA, Sheridan J, Sellman JD, et al.: Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness. Addict Behav. 2011; 36(6): 636-642. DOI: 10.1016/j.addbeh.2011.01.004.

Linge-Dahl L, Vranken M, Juenger S, et al.: Identification of challenges to the availability and accessibility of opioids in twelve European countries: Conclusions from two ATOME Six-Country workshops. J Palliat Med. 2015; 18(12): 1033-1039. DOI: 10.1089/jpm.2015.0051.

Cooper HLF, Cloud DH, Young AM, et al.: When prescribing isn't enough—Pharmacy-level barriers to buprenorphine access. N Engl J Med. 2020; 383(8): 703-705. DOI: 10.1056/NEJMp2002908.

Larney S, Peacock A, Leung J, et al.: Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: A systematic review. Lancet Glob Health. 2017; 5(12): e1208-e1220. DOI: 10.1016/S2214-109X(17)30373-X.

Rao R: The journey of opioid substitution therapy in India: Achievements and challenges. Indian J Psychiatry. 2017; 59(1): 39-45. DOI: 10.4103/psychiatry.IndianJPsychiatry_37_17.

Substance Abuse and Mental Health Services Administration: Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. 2018. Available at https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report. Accessed January 23, 2020.

Andrilla CHA, Moore TE, Patterson DG, et al.: Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: A 5-year update: Distribution of providers with a DEA waiver. J Rural Health. 2019; 35(1): 108-112. DOI: 10.1111/jrh.12307.

Dunlop A, Lokuge B, Masters D, et al.: Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J. 2020; 17(1): 26. DOI: 10.1186/s12954-020-00370-7.

Slavova S, Rock P, Bush HM, et al.: Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Dependence. 2020; 214: 108176. DOI: 10.1016/j.drugalcdep.2020.108176.

Glick SN, Prohaska SM, LaKosky PA, et al.: The impact of COVID-19 on syringe services programs in the United States. AIDS Behav. 2020; 24(9): 2466-2468. DOI: 10.1007/s10461-020-02886-2.

Radfar SR, De Jong CA, Farhoudian A, et al.: Reorganization of substance use treatment and harm reduction services during the COVID-19 pandemic: A global survey. medRxiv. 2020. DOI: 10.1101/2020.09.21.20199133.

University of Michigan Injury Prevention Center: System for opioid overdose surveillance (SOS). 2020. Available at http://injurycenter.umich.edu/opioid-overdose/opioid-surveillance/. Accessed January 13, 2021.

BC Coroners Service: Illicit drug toxicity deaths in BC. Ministry of Public Safety and Solicitor General. 2020. Available at https://www2.gov.bc.ca/assets/gov/birth-adoption-deathmarriage-and-divorce/deaths/coroners-service/statistical/illicitdrug.pdf. Accessed December 23, 2020.

Pearce LA, Min JE, Piske M, et al.: Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: Population based retrospective cohort study. BMJ. 2020; 368: m772. DOI: 10.1136/bmj.m772.

Cone DC, Bogucki S, Burns K, et al.: Naloxone use by emergency medical services during the COVID-19 pandemic: A national survey. J Addict Med. 2020; 14(6): e369-e371. DOI: 10.1097/ADM.0000000000000746.

D'Onofrio G, McCormack RP, Hawk K: Emergency departments—A 24/7/365 option for combating the opioid crisis. N Engl J Med. 2018; 379(26): 2487-2490. DOI: 10.1056/NEJMp1811988.

Wang QQ, Kaelber DC, Xu R, et al.: COVID-19 risk and outcomes in patients with substance use disorders: Analyses from electronic health records in the United States. Mol Psychiatry. 2021; 26: 30-39. DOI: 10.1038/s41380-020-00880-7.

Opioid Treatment Providers Resources and Information: Available at https://www.samhsa.gov/medication-assisted-treatment/otp-resources. Accessed January 13, 2021.

Lacktman N: Prescribing controlled substances without an in-person exam: The practice of telemedicine under the Ryan Haight Act. Becker's Healthcare. 2017. Available at https://www.foley.com/en/insights/publications/2017/04/prescribing-controlled-substances-without-an-inper. Accessed January 14, 2021.

Pytell JD, Rastegar DA: Down the drain: Reconsidering routine urine drug testing during the COVID-19 pandemic. J Subst Abuse Treat. 2021; 120: 108155. DOI: 10.1016/j.jsat.2020.108155.

Crowley D, Homeniuk R, Delargy I: Scoping review protocol: The use of telemedicine in providing opioid agonist treatment and related psychosocial supports. BMJ Open. 2020; 10(12): e040556. DOI: 10.1136/bmjopen-2020-040556.

Arunogiri S, Lintzeris N: Depot buprenorphine during COVID-19 in Australia: Opportunities and challenges. J Subst Abuse Treat. 2021; 124: 108221. DOI: 10.1016/j.jsat.2020.108221.

Lintzeris N, Hayes DV, Arunogiri DS: Interim guidance for the delivery of medication assisted treatment of opioid dependence in response to COVID-19: A national response. 2020. Available at https://www.racp.edu.au/docs/default-source/news-and-events/covid-19/interim-guidance-delivery-of-medication-assisted-treatment-of-opiod-dependence-covid-19.pdf?sfvrsn=e36eeb1a_4. Accessed January 14, 2021.

Alexander GC, Stoller KB, Haffajee RL, et al.: An epidemic in the midst of a pandemic: Opioid use disorder and COVID-19. Ann Intern Med. 2020. DOI: 10.7326/M20-1141.

Clarke H, Weinrib A, Kotteeswaran Y, et al.: Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future. Can J Pain. 2020; 4(1): 224-235. DOI: 10.1080/24740527.2020.1795634.

CRISM_NationalGuideline_OUD-ENG.pdf: Available at https://crism.ca/wp-content/uploads/2018/03/CRISM_NationalGuideline_OUD-ENG.pdf. Accessed January 10, 2021.

COVID-19: Guidance for commissioners and providers of services for people who use drugs or alcohol. GOV. UK. Available at https://www.gov.uk/government/publications/covid-19-guidance-for-commissioners-and-providers-of-services-for-people-who-use-drugs-or-alcohol/covid-19-guidancefor-commissioners-and-providers-of-services-for-people-whouse-drugs-or-alcohol. Accessed January 14, 2021.

Guidance-on-Contingency-Planning-for-PWUD-and-COVID19-V2.0-May-2020.pdf: Available at http://www.sdf.org.uk/wp-content/uploads/2020/05/Guidance-on-Contingency-Planning-for-PWUD-and-COVID19-V2.0-May-2020.pdf. Accessed January 14, 2021

Roncero C, Vicente-Hernández B, Casado-Espada NM, et al.: The impact of COVID-19 pandemic on the castile and Leon addiction treatment network: A real-word experience. Front Psychiatry. 2020; 11: DOI: 10.3389/fpsyt.2020.575755.

IPS-HGS-0265-IPS-Interim-Guidelines-OST-03-04-2020. pdf: Available at https://indianpsychiatricsociety.org/wp-content/uploads/2020/04/IPS-HGS-0265-IPS-Interim-Guidelines-OST-03-04-2020.pdf. Accessed January 14, 2021.

Basu D, Ghosh A, Subodh BN, et al.: 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): 322-326. DOI: 10.4103/psychiatry.IndianJPsychiatry_295_20.

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. DOI: 10.1016/j.ajp.2020.102377.

Tyndall M: Safer opioid distribution in response to the COVID-19 pandemic. Int J Drug Policy. 2020; 83: 102880. DOI: 10.1016/j.drugpo.2020.102880.

Roberts J, White B, Attalla D, et al.: Rapid upscale of depot buprenorphine (CAM2038) in custodial settings during the early COVID-19 pandemic in New South Wales, Australia. Addiction. DOI: 10.1111/add.15244.

Bandara S, Kennedy-Hendricks A, Merritt S, et al.: Early effects of COVID-19 on programs providing medications for opioid use disorder in jails and prisons. J Addict Med. 2020; 14(5): e257-e260. DOI: 10.1097/ADM.0000000000000718.

Bao Y, Williams AR, Schackman BR: COVID-19 could change the way we respond to the opioid crisis—for the better. Psychiatr Serv. 2020; 71(12): 1214-1215. DOI: 10.1176/appi.ps.202000226.

Cance JD, Doyle E: Changes in outpatient buprenorphine dispensing during the COVID-19 pandemic. JAMA. 2020; 324(23): 2442-2444. DOI: 10.1001/jama.2020.22154.

Uscher-Pines L, Sousa J, Raja P, et al.: Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine. J Subst Abuse Treat. 2020; 118: 108124. DOI: 10.1016/j.jsat.2020.108124.

Meteliuk A, Galvez de Leon SJ, Madden LM, et al.: Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine. J Subst Abuse Treat. 021; 121: 108164. DOI: 10.1016/j.jsat.2020.108164.

Frost M: Buprenorphine maintenance treatment in patients with opioid use disorder diagnosed with COVID-19. J Opioid Manag. 2020; 16(6): 405-407. DOI: 10.5055/jom.2020.0598.

Samuels EA, Clark SA, Wunsch C, et al.: Innovation during COVID-19: Improving addiction treatment access. J Addict Med. 2020; 14(4): e8-e9. DOI: 10.1097/ADM.0000000000000685.

Fuchs-Leitner I, Yazdi K, Gerstgrasser NW, et al.: Developments in drug addiction during COVID-19—An Austrian perspective based on a clinical sample. Front Psychiatry. 2020; 11: 602033. DOI: 10.3389/fpsyt.2020.602033.

Wilkinson R, Hines L, Holland A, et al.: Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: Implications for the ongoing COVID-19 response. Harm Reduct J. 2020; 17: 95. DOI: 10.1186/s12954-020-00445-5.

European Monitoring Center for Drugs and Drug Addiction Guidelines. 2021. Available at https://Emcdda.europa.eu. Accessed April 28, 2021.

Clinical Guidelines for Opioid Substitution Treatment: College of Psychiatrists of Ireland. Available at https://www.hse.ie/eng/services/publications/primary/clinical-guidelines-for-opioid-substitution-treatment.pdf. Accessed April 28, 2021.

Guidance on Contingency Planning for people who use drugs and Covid-19: Scottish drug forum. Available at http://www.sdf.org.uk/covid-19-guidance/. Accessed April 28, 2021. 62. Oesterle TS, Kolla BP, Rummans TA, et al.: Medication-assisted therapies for opioid use disorders in patients with chronic pain. J Neurol Sci. 2020; 411: 11678. DOI: 10.1016/j.jns.2020.116728.

D’Onofrio G, Venkatesh A, Hawk K: The adverse impact of COVID-19 on individuals with OUD highlights the urgent need for reform to leverage emergency department-based treatment. NEJM Catal Innov Care Deliv. 2020; 10: 1056. DOI: 10.1056/CAT.20.0190.

Wilson CG, Ramage M, Fagan EB: A primary care response to COVID-19 for patients with an opioid use disorder. J Rural Health. 2021; 37: 169-171. DOI: 10.1111/jrh.12438.

Pal A, Gondwal R, Aulakh APS, et al.: COVID-19-related lockdown breaking the chain of opioid substitution services: An experience from Dehradun, India. Indian J Psychol Med. 2020; 42(5): 496-498.

Nguyen TD, Gupta S, Ziedan E, et al.: Assessment of filled buprenorphine prescriptions for opioid use disorder during the coronavirus disease 2019 pandemic. JAMA Intern Med. 2021; 181(4): 562-565. DOI: 10.1001/jamainternmed.2020.7497.




DOI: https://doi.org/10.5055/jom.2021.0649

Refbacks

  • There are currently no refbacks.