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

Kim Corace; Kelly Suschinsky; Jennifer Wyman; Pamela Leece; Sue Cragg; Sarah Konefal; Priscille Pana; Susan Barrass; Amy Porath; Brian Hutton

doi:10.1016/j.drugpo.2021.103573

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

Int J Drug Policy. 2022 Apr:102:103573. doi: 10.1016/j.drugpo.2021.103573. Epub 2021 Dec 23.

Authors

Kim Corace¹, Kelly Suschinsky², Jennifer Wyman³, Pamela Leece⁴, Sue Cragg⁵, Sarah Konefal⁵, Priscille Pana⁵, Susan Barrass⁵, Amy Porath⁵, Brian Hutton⁶

Affiliations

¹ 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.
² Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, 1145 Carling Ave., Ottawa, ON, K1Z 7K4, Canada.
³ 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.
⁴ 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.
⁵ Canadian Centre on Substance Use and Addiction, 75 Albert Street, #500, Ottawa, ON, K1P 5E7, Canada.
⁶ 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.

Abstract

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.

Keywords: Buprenorphine; COVID-19; Methadone; Opioid agonist treatment; Slow-release oral morphine; Unsupervised doses.

Publication types

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

MeSH terms

Analgesics, Opioid
Buprenorphine*
COVID-19*
Humans
Methadone
Ontario
Opiate Substitution Treatment / methods
Opioid-Related Disorders* / drug therapy
Pandemics

Substances

Analgesics, Opioid
Buprenorphine
Methadone