key: cord-0759986-qdeh7y3l
authors: Tracy, Kathlene; Wachtel, Leah; Friedman, Teri
title: The impact of COVID-19 on opioid treatment program (OTP) services: Where do we go from here?
date: 2021-04-09
journal: J Subst Abuse Treat
DOI: 10.1016/j.jsat.2021.108394
sha: 0ec0522c4ddd40bb353496b35725b26777ba6bfc
doc_id: 759986
cord_uid: qdeh7y3l

Medication for opioid use disorder (MOUD) services are key to addressing the opioid crisis and COVID-19 has significantly impacted them. The need for social distancing and self-quarantining requires individuals to maintain personal physical space and limits face-to-face interactions, which are required for methadone dispensing and other regulated treatment activities. Mount Sinai Beth Israel, which has one of the largest opioid treatment service (OTP) delivery systems within the United States and includes 10 OTP methadone clinics, responded rapidly, implementing procedures to address the additional challenges during the COVID-19 pandemic. This article discusses four key procedural areas: 1) verified identity in-person pick-up doses, 2) drug urine toxicology screens, 3) treatment interactions, and 4) discharges, which can inform future OTP operational procedures by encouraging out-of-the-box thinking in this new age.

The opioid crisis is a nationwide public health emergency (Centers for Disease Control, 2020; Hargan, 2018) . Essential medication for opioid use disorder (MOUD) faces significant impacts from COVID-19 (Bell & Strang, 2020; Connery, 2015; Sun et al., 2020) . Mount Sinai Beth Israel (MSBI) has one of the largest opioid use services within the country, including 10 operating opioid treatment programs (OTPs). Located within the pandemic epicenter, New York City (NYC), we responded swiftly to COVID-19, knowing the challenges in delivering opioid treatment and impact to regulated operational procedures (Substance Abuse and Mental Health Service Administration, 2020; The Joint Commission, 2020).

Methadone is a controlled substance that physicians administer to individuals with opioid use disorders (OUDs); it requires a regimented treatment trajectory with regulations outlining training for prescribers, storage, dissemination, and continued evaluation (Atterman et al., 2018) .

Challenges to methadone dispensing arose due to the COVID-19 pandemic, stemming from the increased need for social distancing and isolation (Alexander & Stoller, 2020), which required personal space and limits on face-to-face interactions, necessary components of methadone dispensing and treatment. Reports indicate that COVID-19 has reduced onsite medication visits close to half, with patients continuing treatment having accommodations for take-home medication and delivery services (Peavey et al., 2020) .

Within our addiction service delivery system's 10 OTP methadone clinics, we rapidly implemented procedures to address four key areas that COVID-19 impacted.

a controlled substance so as to reduce overdose risks. Pre-COVID-19, patients picked up medication 6 days per week if new to treatment or actively using. During COVID-19, we implemented a rapid reduction in pick-up dose requirement, including 14-day and 28-day dose coverage for single pick-ups for those patients not new to treatment or using who did not reach stability yet; transition varied depending on the individual patient's characteristics. Medication J o u r n a l P r e -p r o o f visits dropped 38% from the same time the previous year, primarily due to these changes and shifting resources. All patients had their pick-up schedule frequency changed per clinical review, excluding active use and new patients, to ensure dosage stability.

Patients in quarantine, either at isolation hotels or elsewhere due to contracting or high risk for COVID-19, had courier-delivered medication, provided through NYC Department of Health and Mental Hygiene. The eligible patients were those who were symptomatic, tested positive, high risk, or exposed to someone with COVID-19.

2) Our OTPs use drug urine toxicology screens to ensure abstinence from all substances and to determine treatment course. Our OTPs use urine toxicology screens more frequently at treatment onset to capture use when initially becoming acquainted with new patients' use patterns and when suspecting substance use. Frequency of drug screens remained the same during COVID-19 for patients new to treatment or for those suspected of use, as they were already frequent. The OTPs required additional monthly urine toxicology screens for all, rather than random assessment, due to the increased take-home doses to ensure safety. Future guidance should explore virtual urine toxicology immediate result screens and potential for outside local lab specimen screens.

3) Accrediting bodies require treatment interactions and time regulate them to safely deliver MOUD (e.g., intakes, treatment plans, therapy, physicals). At the onset of the COVID-19 pandemic, we promptly shifted toward phone and virtual interactions where appropriate, with many of our staff working remotely and those in clinic wearing protective equipment. The clinic

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