Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19

Beth E Meyerson; Keith G Bentele; Benjamin R Brady; Nick Stavros; Danielle M Russell; Arlene N Mahoney; Irene Garnett; Shomari Jackson; Roberto C Garcia; Haley B Coles; Brenda Granillo; Gregory A Carter

doi:10.1016/j.focus.2023.100177

Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19

AJPM Focus. 2023 Dec 24;3(2):100177. doi: 10.1016/j.focus.2023.100177. eCollection 2024 Apr.

Authors

Beth E Meyerson^{1

2}, Keith G Bentele^{1

3}, Benjamin R Brady^{1

2

4}, Nick Stavros^{5

6}, Danielle M Russell^{1

6

7}, Arlene N Mahoney^{1

6

8}, Irene Garnett^{1

6}, Shomari Jackson⁹, Roberto C Garcia⁹, Haley B Coles⁹, Brenda Granillo³, Gregory A Carter^{1

10

11}

Affiliations

¹ Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona.
² Comprehensive Center for Pain and Addiction, The University of Arizona Health Sciences, Tucson, Arizona.
³ Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona.
⁴ School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, Michigan.
⁵ Community Medical Services, Phoenix, Arizona.
⁶ Drug Policy Research and Advocacy Board, Tucson, Arizona.
⁷ Kirby Institute, University of New South Wales, Sydney, Australia.
⁸ Southwest Recovery Alliance, Phoenix, Arizona.
⁹ Sonoran Prevention Works, Phoenix, Arizona.
¹⁰ Department of Community and Health Systems, Indiana University School of Nursing, Indiana University, Bloomington, Indiana.
¹¹ Rural Center for AIDS/STD Prevention, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana.

Abstract

Introduction: This study examined the impact of federal regulatory changes on methadone and buprenorphine treatment during COVID-19 in Arizona.

Methods: A cohort study of methadone and buprenorphine providers from September 14, 2021 to April 15, 2022 measured the proportion of 6 treatment accommodations implemented at 3 time periods: before COVID-19, during Arizona's COVID-19 shutdown, and at the time of the survey completion. Accommodations included (1) telehealth, (2) telehealth buprenorphine induction, (3) increased multiday dosing, (4) license reciprocity, (5) home medications delivery, and (6) off-site dispensing. A multilevel model assessed the association of treatment setting, rurality, and treatment with accommodation implementation time.

Results: Over half (62.2%) of the 74-provider sample practiced in healthcare settings not primarily focused on addiction treatment, 19% practiced in methadone clinics, and 19% practiced in treatment clinics not offering methadone. Almost half (43%) were unaware of the regulatory changes allowing treatment accommodation. Telehealth was most frequently reported, increasing from 30% before COVID-19 to 80% at the time of the survey. Multiday dosing was the only accommodation substantially retracted after COVID-19 shutdown: from 41% to 23% at the time of the survey. Providers with higher patient limits were 2.5-3.2 times as likely to implement telehealth services, 4.4 times as likely to implement buprenorphine induction through telehealth, and 15.2-20.9 times as likely to implement license reciprocity as providers with lower patient limits. Providers of methadone implemented 12% more accommodations and maintained a higher average proportion of implemented accommodations during the COVID-19 shutdown period but were more likely to reduce the proportion of implemented accommodations (a 17-percentage point gap by the time of the survey).

Conclusions: Federal regulatory changes are not sufficient to produce a substantive or sustained impact on provider accommodations, especially in methadone medical treatment settings. Practice change interventions specific to treatment settings should be implemented and studied for their impact.

Keywords: Telehealth; buprenorphine; federal regulatory policy; methadone; multiday methadone dosing; policy implementation.