Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms

• Published in: Journal of substance abuse treatment Vol. 132; p. 108514
• Main Authors: Treitler, Peter C., Bowden, Cadence F., Lloyd, James, Enich, Michael, Nyaku, Amesika N., Crystal, Stephen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022; Elsevier Limited
• Subjects: Autonomy; Buprenorphine; Buprenorphine - therapeutic use; Changes; Coronaviruses; Counseling services; COVID-19; Drugs; Humans; Interviews; Medication for addiction treatment; Medication for opioid use disorder; Methadone; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders - drug therapy; Opioids; Pandemics; Patient-centered care; Patients; Psychosocial factors; Psychosocial intervention; SARS-CoV-2; Substance abuse treatment; Substance use disorder; Telehealth; Telemedicine; Toxicology; COVID-19; Medication for opioid use disorder; Methadone; Telehealth; Buprenorphine; Medication for addiction treatment
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2021.108514

The COVID-19 pandemic led to unprecedented temporary federal and state regulatory flexibilities that rapidly transformed medication for opioid use disorder (MOUD) treatment delivery. This study aimed to understand changes in treatment providers' care during COVID-19, provider experiences with the adaptations, and perceptions of which changes should be sustained long-term. We conducted in-depth, semi-structured interviews with 20 New Jersey MOUD providers, purposively sampled to reflect diversity in provider setting, specialty, and other characteristics. Using a rapid analysis approach, we summarized content within interview domains and analyzed domains across participants for recurring concepts and themes. MOUD treatment practice changes taking place during the COVID-19 pandemic included a rapid shift from in-person care to telehealth, reduction in frequency of toxicology testing and psychosocial/counseling services, and modifications to prescription durations and take-home methadone supplies. Modifications to practice were positively received and reinforced a sense of autonomy for providers as well as enhancing the ability to provide patient-centered care. All respondents expressed support for making temporary regulatory flexibilities permanent, but differed in their implementation of the flexibilities and the extent to which they planned to modify their own practices long-term. Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic. •MOUD service delivery changed considerably in response to the COVID-19 pandemic.•Service adaptations eased the burden of the pandemic on patients and providers.•Providers differed in their implementation of regulatory flexibilities.•Regulatory flexibilities allowed providers to better individualize care.•Providers expressed support for making temporary regulatory flexibilities permanent.