Health Reform WK-EDGE Opioid treatment centers challenged because of COVID-19 pandemic
Tuesday, December 8, 2020

Opioid treatment centers challenged because of COVID-19 pandemic

By Donielle Tigay Stutland, J.D.

OIG releases report highlighting the challenges opioid treatment programs have had during the pandemic, as well as the actions taken to address challenges to maintain pre-pandemic service levels.

As the U.S. currently faces two public health crises, the opioid crisis and the COVID-19 pandemic, the OIG sought to assess the impact the COVID-19 pandemic has had on Opioid Treatment Centers (OTPs) ability to deliver care, as well as the actions taken by OTPs to address these challenges. In an audit to ascertain the impact the COVID-19 pandemic has had on OTPs, the OIG conducted interviews with 142 OTPs during June 2020, after randomly selected 150 OTPs nationwide of the 1,746 OTPs. The 142 OTPs who provided responses are located in 37 states and the District of Columbia. OIG completed the audit seeking to identify: (1) challenges that OTPs have encountered during the COVID-19 pandemic and (2) actions that OTPs have taken to address those challenges while ensuring the continuity of needed services and protecting the health and safety of their patients and staff (OIG Report, A-09-20-01001, November 18, 2020).

Background. The OIG report suggests that individuals who use opioids may be at higher risk for contracting COVID-19, because, "they are more likely to: (1) be homeless, poor, smokers with lung or cardiovascular disease, or uninsured or underinsured or (2) have serious health and socioeconomic issues from drug addiction." Additionally, the COVID-19 pandemic has had negative consequences on mental health, and the report notes a correlation between opioid use and mental health conditions prior to the pandemic. The report indicates that anecdotal evidence has shown an increase in opioid overdoses during the pandemic.

OTPs are the "front line" in responding to the opioid crisis, and often provide daily medication-assisted treatment (MAT) programs to patients, such as methadone or buprenorphine (through daily visits to pick up the allotted dosage), as well as counseling and therapy. Given the COVID-19 pandemic, OTPs have been allowed some flexibility with offering "take-home" doses, as well as temporary exemptions for OTPs from having to perform in-person physicals prior to starting buprenorphine dosage, as all as allowing some tele-health intakes. Additionally, there has been guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA), DEA and CDC related to the health and safety of patients while delivering treatment during the COVID-19 pandemic.

Findings. The audit revealed a variety of challenges for OTPs due to the COVID-19 pandemic. Challenges described by OTPs included: (1) maintaining pre-pandemic service levels (124 OTPs); (2) managing impacts on facility operations (113 OTPs); (3) implementing and using tele-health (87 OTPs); (4) obtaining treatment medications, personal protective equipment (PPE),35 and cleaning supplies (83 OTPs); (5) maintaining patient participation in OTP activities (77 OTPs); (6) dealing with limitations posed by existing Federal guidance (65 OTPs); (7) providing take home doses to patients (51 OTPs); and (8) implementing governmental guidance (34 OTPs).

The report quoted one OTP: "[MAT] hinges on face-to-face interaction as it is personalized to each patient, so some of the effectiveness is lost from not being onsite and having [personal or face-to-face] interaction." Another noted that after implementing social distancing measures in its facility, staff were not able to observe the collection of patients’ urine samples for required drug tests.

OTPs reported other specific challenges related to: (1) determining how best to provide services to each of their patients, including those who had tested positive for COVID-19 or were in quarantine because of exposure to someone who had tested positive; (2) admitting new patients because medical staff who performed physical examinations of patients were working limited schedules; (3) obtaining physical examinations or blood tests from outside providers because the providers were no longer furnishing those services; (4) scheduling patients for counseling sessions because OTPs did not always have accurate contact information for patients, OTPs were challenged by coordinating patient schedules with clinic counseling schedules, and some patients would not participate in tele-health; and (5) following up with patients who were approved for take-home doses.

Actions Taken. OTPs reported a wide variety of actions taken to help ensure that patients received medications and treatments during the pandemic. Commonly reported actions taken by OTPs, include: (1) encouraging or requiring various personal safety measures for patients and staff (141 OTPs), (2) implementing or expanding the use of tele-health to continue providing services (128 OTPs), (3) increasing the number of take-home doses to reduce the number of patients visiting facilities (127 OTPs), (4) making physical changes to facilities and increasing staffing flexibilities (121 OTPs), and (5) ensuring that patients received treatment medications (92 OTPs).

Additionally, OTPs reported administering curbside dosing as a way to mitigate risks of COVID-19. One OTP official reported curbside dosing as being a "game changer," in preventing the spread of COVID-19. A large number of OTPs reported using tele-health technologies, not just for new patient admissions, but for group and individual counseling sessions, as well as for support groups and psychiatric services. With respect to counseling, one OTP found its patients "more willing" to participate in hour-long conversation over the phone than in person.

Additional Flexibilities. OTPs reported that they would like to have more flexibilities to better serve their patients. OTPs also reported that some of the flexibilities afforded by SAMHSA as a result of the pandemic have produced positive results related to patient retention rates, patient engagement in counseling and patient no-shows.

SAMHSA Comments. A draft copy of the report was sent to SAMHSA, and it commented on measures it has taken to address the impact of COVID-19, including "rapid dissemination of guidance and support." In its comment letter, SAMHSA stated that it had worked closely with State Opioid Treatment Authorities to authorize extended take-home medications for those with opioid use disorder, and that it had worked with DEA to waive the requirement for an in-person physical exam for new patients receiving buprenorphine and to permit the use of tele-health visits for established patients with opioid use disorder. SAMHSA commented that it has provided assistance and training during the pandemic for OTPs, including tele-health training for mental health providers.

ReportsLetters: OIGReports AgencyNews DrugNews GeneralNews NewsFeed

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