Maintaining Access to OUD Treatment During the COVID-19 Pandemic

Karen Scott, MD, MPH, President of the Foundation for Opioid Response Efforts (FORE), New York, New York, explains how the COVID-19 pandemic affected access to treatment for opioid use disorder (OUD) and discusses policy changes that would allow maximum access to OUD treatment and recovery services. These topics were among those addressed at the recent virtual Rx Drug Abuse & Heroin Summit.  

Read the transcript:

How did the COVID-19 pandemic affect patients' access to OUD treatment and recovery services? 

We know that transitions are hard for all of us and particularly for people who are more vulnerable because they're struggling with staying in treatment for opioid use disorder.

The abrupt changes in delivery of care last spring, last March and April, certainly took some time for everyone to get used to. Providers had to figure out how to switch to using technology to doing visits over telehealth. Patients had to get used to how to use the technology, how to turn on their computers, how to connect with providers and feel comfortable doing it.

Certainly, some challenges and some disruptions in access to care, particularly last spring, obviously coupled with a point in time where necessary lockdowns, isolation, was probably at its highest and was a new concept for everyone.

As we, unfortunately, are seeing reflected in the data that's coming out from CDC, we had a significant increase in overdoses, particularly starting last spring as these factors really came together in the worst of ways.

What we did see over the next few months though is that providers got more comfortable and figured out how to use the technology. They worked closely with their patients to get patients to become comfortable and make use of the technology.

Frankly, for some patients, particularly in more rural areas or parents at home who might have other family care and childcare responsibilities, having the flexibility and doing visits remotely and via telehealth actually improved their ability to stick with treatment and to maintain their access to care.

We are learning, in the midst of learning, a lot about what has worked well during the pandemic to improve access to care as well as understanding that there have been challenges, certainly, for rural populations.

We are supporting a set of projects now to really study and learn as much as we can around the country about what has worked well, which of the flexibilities in terms of prescribing buprenorphine, managing patients remotely, which are working well, which would we like to see maintained, which patients are getting good care that way, and who is it not working for that we need to continue to look at other ways of improving their access.

Similarly, the flexibilities that were provided by the federal government for opioid treatment programs, flexibilities in terms of expanding methadone take-home doses, getting some health departments delivering methadone to people rather than people having to come daily to a clinic.

Also providing really important flexibility that's allowed more people to maintain their access and indeed, in some places, improve access to their treatment services.

What permanent policy changes do you think are most important to allow maximum access to OUD treatment and recovery services? (3:45)

Firstly, I would say, again, we have this unique opportunity to learn a lot from the past year and make sure we're using what we learn to inform longer-term policy changes.

I was just speaking about the flexibility that the changes in telehealth regulations during the pandemic has afforded many providers and many patients. We know that providers spent a lot of time early on in doing outreach with their patients to get them comfortable with telehealth.

We know some patients are anxious to get back to in-person visits, but for many, this will become a regular part of the way that they receive their care and that they want to receive their care.

I would say the first set of regulations or long-term policies that we are looking forward to seeing strengthened and improved over the long term would be maintaining flexibility in the ways we use telehealth, flexibility in terms of prescribing, flexibility in terms of being able to use the technology to, again, do some of that remote work and outreach and taking care and using those platforms to really get care to where patients are rather than always expecting the patients to come into a clinic or into the hospital.

The second opportunity in terms of longer-term policy is to look at some of the flexibilities that the opioid treatment programs have had during the pandemic. As I've heard my board chair and others say, use this as an opportunity to modernize the methadone program.

We are supporting a project with a team at Yale to specifically focus on what some of the impacts and outcomes have been by having flexibility to increase the take-home doses of methadone during the pandemic, flexibility to reduce how often people are coming into the OTP program onsite, reduce how much drug screening, testing, is being done, and try to answer some of the questions about what the clinical outcomes are for the patients, whether there are any negative outcomes on issues such as diversion and really very much use that data and others like it to help drive us to a new place of thinking about how opioid treatment programs and programs across the board for delivering medications of opioid use disorder can be more flexible and thereby more accessible to more people.

Dr. Karen Scott has more than 20 years of experience in health care policy, quality improvement, health services research, and public health. She has worked with public health and delivery system leaders to redesign care and promote health equity, quality and patient safety, and population health improvement. Dr. Scott has led large-scale change initiatives within delivery systems, focusing on public and safety net providers, and the populations they serve. She served as Chief Medical Officer in the Office of Assistant Secretary for Health at the US Department of Health and Human Services (HHS). Dr. Scott also collaborated to advance policy on social determinants of health and concurrently served in the role of interim acting director of the HHS Office on Women’s Health. Dr. Scott is a board-certified physician in preventive medicine.