Impacts of COVID-19 at an Urban, Public Hospital-Based MAT Clinic

Introduction
The gaps in resources for those struggling with opioid use disorder (OUD) were especially highlighted during state-wide and region-wide COVID-19 lockdowns including interruptions in OUD treatment and medication assisted therapy (MAT) center operations.1,2 This study aimed to evaluate if the reduction in counseling services, group support, and visit frequency implemented during a state-wide physical distancing mandate negatively impacted patients’ recovery at a single urban, publicly-funded MAT and OUD treatment clinic.

Methods
This is a single-center retrospective cohort study. Baseline data collected included demographics; medical, psychiatric history and concurrent substance abuse history; clinic enrollment related data: length of time enrolled in clinic, length of time in OUD treatment, length of remission from opioid use, length of remission from other substance use; OUD severity classification per Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria3; type of MAT and dose. Charts were reviewed for data regarding opioid and non-opioid substance use, evidenced by urine drug screens, six weeks prior to and six weeks after, implementation of COVID-19 physical distancing measures. Binary and count outcomes were evaluated using binary logistic and Poisson generalized estimating equations, respectively.

Results

Fifty-three patients were included; 33 (62%) were male and the median age was 43 years (interquartile rage [IQR]: 32.5 – 51.5). Thirty-five (66%) were employed and 28 (52.8%) had a stable housing. Patient opioid use disorder sub-categories included opioid use disorder, severe, on maintenance therapy (N = 18, 34%); opioid use disorder, severe, in early remission, on maintenance therapy (N = 13, 24.5%); opioid use disorder, severe, in sustained remission, on maintenance therapy (N = 22, 41.5%). Overall, neither opioid use (OR 1.01 [95% CI 0.62 – 1.62]) nor non-opioid substance use (1.39 [95% CI 0.91 – 2.13]) increased post COVID-19 distancing measures implementation. When sub-stratified, those patients who had met DSM-5 criteria for sustained remission, on MAT, were less likely to have recurrence of opioid use or other substance use, when compared to those who were newly engaged in treatment, and those who had achieved early remission (OR = 1.72, 95% CI: 1.15 - 2.58).

Conclusions
This study illustrates that those who were earliest in recovery were more likely to have recurrence of opioid or non-opioid drug use secondary to challenges that COVID-19 created. This brings to light that resources likely need to be proportionately directed to those in early remission, or less, from OUD, during the COVID-19 pandemic.

References: 1. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine. 2020.
2. Centers for Disease Control and Prevention. Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html. Published 2020. Accessed May 8, 2020.
3. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., ... & Schuckit, M. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851.