(29) COVID-19 Implications in Mental Health and Opioid Use Disorder Treatment: Qualitative Study

Introduction: Federal agencies announced in March 2020 regulatory changes for opioid treatment programs (OTPs) to ensure patient and staff safety – extended methadone take-home dosing and increased use of telehealth counseling. Qualitative interviews explored OTP patient and staff perceptions on how the COVID 19 pandemic and these regulatory changes impacted addiction treatment engagement and recovery support.

Methods: Semi-structured, one-to-one telephone interviews were completed between August 2020 and January 2021 with 46 patients with varying amounts of take-home doses and 6 staff from 3 rural OTPs in Oregon. Interviews were audio-recorded, and transcribed verbatim. Transcriptions were coded at the semantic level, with codes generated both deductively and inductively. Directed content analysis extracted themes in an iterative process.

Results: Staff worried more than patients about return to opioid use due to COVID-19 related stressors. Staff were concerned about reduced contact and interaction with patients they previously had with group and individual counseling, despite telemedicine availability. Patients voiced anxiety about contracting COVID-19 or transmitting the virus to their families and communities while engaging in methadone treatment. A few patients with extended methadone take-home regimens requested to return to daily clinic dosing for enhanced staff/clinic support stating they were “too new in recovery.” Some patients struggled with their mental health, noting social isolation, and missing the usual recovery supports of in-person counseling at the OTP. Others, however, stated it helped to “keep to yourself.”

Conclusions: OTPs perform a vital service of providing patients mental health services during public health emergencies. During COVID, patients and staff reflected on adjusting to new regulatory procedures and policies, despite increased anxiety and changing support needs. There was a range of preferences, signaling that a single approach may work for most but can be detrimental to some. To the extent it is feasible, OTPs should offer more individualized treatment plans.

References: Joseph G, Torres-Lockhart K, Stein MR, Mund PA, Nahvi S. Reimagining patient-centered care in opioid treatment programs: Lessons from the Bronx during COVID-19. J Subst Abuse Treat. 2020;(November):108219.
McIlveen JW, Hoffman K, Priest KC, Choi D, Korthuis PT, McCarty D. Reduction in Oregon’s Medication Dosing Visits After the SARS-CoV-2 Relaxation of Restrictions on Take-home Medication. J Addict Med. 2021;Epub(Ahead of print):3-5.
Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing - The Need for Prevention and Early Intervention. JAMA Intern Med. 2020;180(6):817-818.
Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Services Research. 2019;19(1):884. doi:10.1186/s12913-019-4751-4

Diversity, Equity, and Inclusion: Individuals who live in underserved, rural communities face increased barriers and challenges to access addiction treatment services, especially methadone. We explored the perceptions of patients attending rural opioid treatment programs on how the relaxation of take-home methadone dispensing was implemented in their communities and the implications of these policy changes in their mental health and addiction treatment.