Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients' and prescribers' experiences with changes in unsupervised dosing.

Analgesics, Opioid Buprenorphine COVID-19 Humans Methadone Ontario Opiate Substitution Treatment / methods Opioid-Related Disorders / drug therapy Pandemics
Buprenorphine COVID-19 Methadone Opioid agonist treatment Slow-release oral morphine Unsupervised doses

Journal

The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759

Informations de publication

Date de publication:
04 2022
Historique:
received: 20 07 2021
revised: 09 12 2021
accepted: 16 12 2021
pubmed: 6 2 2022
medline: 1 4 2022
entrez: 5 2 2022
Statut: ppublish

Résumé

The COVID-19 pandemic has exacerbated the opioid crisis. Opioid-related deaths have increased and access to treatment services, including opioid agonist treatment (OAT), has been disrupted. The Ontario COVID-19 OAT Treatment Guidance document was developed to facilitate access to OAT and continuity of care during the pandemic, while supporting physical distancing measures. In particular, the Guidance expanded access to unsupervised OAT dosing. It is important to evaluate the changes in unsupervised OAT dosing after the release of the Ontario COVID-19 OAT Guidance based on patients' and prescribers' reports. Online questionnaires were developed collaboratively with people with lived and living expertise, prescribers, clinical experts, and researchers. Patients (N = 402) and prescribers (N = 100) reported their experiences with changes in unsupervised dosing during the first six months of the pandemic. Many patients (57%) reported receiving additional unsupervised OAT doses (i.e., take away doses). Patients who received additional unsupervised doses were not significantly more likely to report adverse health outcomes compared to patients who did not receive additional unsupervised doses. Patients with additional unsupervised doses and prescribers agreed that changes in OAT care were positive (e.g., reported an improved patient-prescriber relationship and more openness between patient and prescriber). Prescribers and some patients reported the need for continued flexibility in unsupervised doses after the pandemic restrictions lift. Results support the need to re-evaluate historical approaches to OAT care delivery, particularly unsupervised doses. It is crucial to implement policies, regulations, and supports to reduce barriers to OAT care during the pandemic and once the pandemic response restrictions are eased. Flexibility in OAT care delivery, particularly unsupervised dosing, will be key to providing patient-centred care for persons with opioid use disorder.

Sections du résumé

BACKGROUND
The COVID-19 pandemic has exacerbated the opioid crisis. Opioid-related deaths have increased and access to treatment services, including opioid agonist treatment (OAT), has been disrupted. The Ontario COVID-19 OAT Treatment Guidance document was developed to facilitate access to OAT and continuity of care during the pandemic, while supporting physical distancing measures. In particular, the Guidance expanded access to unsupervised OAT dosing. It is important to evaluate the changes in unsupervised OAT dosing after the release of the Ontario COVID-19 OAT Guidance based on patients' and prescribers' reports.
METHOD
Online questionnaires were developed collaboratively with people with lived and living expertise, prescribers, clinical experts, and researchers. Patients (N = 402) and prescribers (N = 100) reported their experiences with changes in unsupervised dosing during the first six months of the pandemic.
RESULTS
Many patients (57%) reported receiving additional unsupervised OAT doses (i.e., take away doses). Patients who received additional unsupervised doses were not significantly more likely to report adverse health outcomes compared to patients who did not receive additional unsupervised doses. Patients with additional unsupervised doses and prescribers agreed that changes in OAT care were positive (e.g., reported an improved patient-prescriber relationship and more openness between patient and prescriber). Prescribers and some patients reported the need for continued flexibility in unsupervised doses after the pandemic restrictions lift.
CONCLUSIONS
Results support the need to re-evaluate historical approaches to OAT care delivery, particularly unsupervised doses. It is crucial to implement policies, regulations, and supports to reduce barriers to OAT care during the pandemic and once the pandemic response restrictions are eased. Flexibility in OAT care delivery, particularly unsupervised dosing, will be key to providing patient-centred care for persons with opioid use disorder.

Identifiants

DOI: 10.1016/j.drugpo.2021.103573 PMID: 35123246 PMC: PMC8695187
pubmed: 35123246
pii: S0955-3959(21)00491-6
doi: 10.1016/j.drugpo.2021.103573
pmc: PMC8695187
pii:
doi:

Substances chimiques

Analgesics, Opioid 0
Buprenorphine 40D3SCR4GZ
Methadone UC6VBE7V1Z

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

103573

Informations de copyright

Copyright © 2021. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declarations of Interest J. Wyman co-authored the Ontario COVID-19 Opioid Agonist Treatment Guidance.

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Auteurs

Kim Corace (K)

Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, 1145 Carling Ave., Ottawa, ON, K1Z 7K4, Canada; Department of Psychiatry, Faculty of Medicine, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada; University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave., Ottawa, ON, K1Z 7K4, Canada; Ottawa Hospital Research Institute, 501 Smyth Road, Box 511, Ottawa, ON, K1H 8L6, Canada. Electronic address: kim.corace@theroyal.ca.

Kelly Suschinsky (K)

Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, 1145 Carling Ave., Ottawa, ON, K1Z 7K4, Canada.

Jennifer Wyman (J)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada; Substance Use Service, Women's College Hospital, 76 Grenville Street, Floor 3, Toronto, ON, M5S 1B2, Canada.

Pamela Leece (P)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada; Substance Use Service, Women's College Hospital, 76 Grenville Street, Floor 3, Toronto, ON, M5S 1B2, Canada; Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada.

Sue Cragg (S)

Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.

Sarah Konefal (S)

Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.

Priscille Pana (P)

Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.

Susan Barrass (S)

Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.

Amy Porath (A)

Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.

Brian Hutton (B)

Ottawa Hospital Research Institute, 501 Smyth Road, Box 511, Ottawa, ON, K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › Evaluating how has care been affected by the...
questionsmedicales.fr › Composés polycycliques › Hydrocarbures aromatiques polycycliques › Phénanthrènes › Morphinanes › Buprénorphine › Evaluating how has care been affected by the...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Evaluating how has care been affected by the...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Evaluating how has care been affected by the...
questionsmedicales.fr › Composés chimiques organiques › Cétones › Méthadone › Evaluating how has care been affected by the...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Evaluating how has care been affected by the...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement de substitution aux opiacés › Evaluating how has care been affected by the...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Troubles liés à l'usage de substances psychotropes › Troubles liés aux opiacés › Evaluating how has care been affected by the...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Épidémies › Pandémies › Evaluating how has care been affected by the...