Opportunities are always out there. They just have to be recognized.
There is one out there right now.
And the Commonwealth of Pennsylvania’s Department of Drug and Alcohol Programs (DDAP), in partnership with Vital Strategies and Johns Hopkins University through the Bloomberg Philanthropies Initiative, are on to it.
The COVID-19 pandemic quickly and significantly altered the way primary health care was delivered. The majority of patient appointments, which usually take place in person, were moved to a virtual platform. This shift was not limited to physical health but included behavioral health. Substance use disorder treatment, especially medication for opioid use disorder (MOUD), presented unique challenges beyond simply shifting to telehealth. This is the where opportunity appears.
Methadone is an effective, safe, but highly regulated medication for stabilizing individuals with a severe opioid use disorder. It is dispensed daily for patients in licensed and accredited Opioid Treatment Programs (OTPs). Some patients, a minority of them, after satisfying a set of criteria, are eligible for “take-home doses.” In other words, a subset of patients does not have to report daily for medication dispensing, but are expected to continue with counseling and supportive services as indicated in their treatment plan.
In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) granted OTPs and states increased flexibility to ensure the delivery of OTP services and to protect patients and staff from COVID-19 to the fullest extent possible. Under SAMHSA’s guidance, states could request blanket exceptions for all stable patients in an OTP to receive up to 28 days of take-home doses. For less stable patients, states could request up to 14 days of take-home medications for patients the OTP believes can safely handle this level of take-home medications.
Pennsylvania requested, received, and implemented these exceptions.
Now the opportunity. Two distinct periods of time have been established, each with different conditions. One, the usual pre-pandemic rules for OTPs, and the second, the pandemic waiver, establishing exceptions to take-home doses of medications.
The Institute for Research, Education and Training in Addictions (IRETA) and Vital Strategies recognized the opportunity to learn about the effect of the waivered rules on take-home medications and telehealth on both the operations of OTP’s and the clinical outcomes and compare them to the pre-pandemic operations and clinical outcomes for OTPs.
When the Pennsylvania Department of Drug and Alcohol Programs (DDAP) was approached with the idea the department, which is the Single State Authority (SSA) for Pennsylvania quickly agreed to the study, and reached out to OTPs to encourage them to complete a survey. DDAP saw this as an opportunity to understand how to manage and improve the quality of care with these new flexibilities during the pandemic. They communicated to OTPs that they would provide support along the way to ensure quality of care as the survey and study took place.
Broadly, the survey was designed to assess how changing circumstances and regulations due to COVID-19 impacted OTP operations, and clinical outcomes. It included questions about how OTPs are adapting safety and medication protocols and of how OTP staff perceive these changes, including their risks and benefits.
The learning objectives of the study were as follows:
- Describe how Pennsylvania OTPs adapted safety protocols, clinical practices, and operations in response to the pandemic.
- Describe perceptions among OTP directors of risks and benefits of the Drug Enforcement Agency’s (DEA) relaxation of regulations around methadone and buprenorphine.
- Identify potential opportunities to expand telemedicine as a modality to provide care for opioid use disorder using agonist medications.
This study aims to help inform next steps for MOUD care in Pennsylvania and increase support to OTP providers and patients.
The survey was developed and sent out by DDAP team on September 15, 2020 was closed on November 20, 2020.
The surveys are being compiled and analyzed by the Johns Hopkins research team in conjunction with Vital Strategies and DDAP. Preliminary results are expected to be released by early spring.