Removing barriers to opioid use disorder treatment shows success during pandemic

Pandemic-era changes to prescribing guidelines for the lifesaving drug buprenorphine led to improved treatment outcomes for patients with opioid use disorder in Philadelphia, according to a recently published study in the journal Drug and Alcohol Dependence Reports from researchers at Drexel University’s Dornsife School of Public Health.

The authors analyzed data from medical records and the Pennsylvania Prescription Drug Monitoring Program for 506 patients who received buprenorphine for the treatment of opioid use disorder at the multi-service harm reduction organization Prevention Point Philadelphia between September 2018 and June 2020. Once the Drug Enforcement Agency (DEA) authorized less-restrictive prescribing regulations, in response to the pandemic, which included telemedicine visits to clients, longer prescriptions and fewer drug screening requirements during the course of treatment, patient retention in treatment improved. Patients accessing providers using telemedicine resources at Prevention Point stayed enrolled an average of 78 days and those accessing providers via telemedicine offsite stayed in care an average of 180 days. This translates to 3-8 times greater duration in treatment compared to those treated before the pandemic.

The findings are a useful case study for policymakers tasked with improving treatment options for the 1.7 million people in the United States experiencing opioid use disorder. Buprenorphine stops or limits the euphoric effects of opioids while making the body experience craving and withdrawal symptoms less often.

“We treated the policy changes as a natural experiment and compared treatment outcomes before and after they took effect,” said lead author Kathleen Ward, a doctoral research fellow at the Dornsife School of Public Health’s Urban Health Collaborative. “We found the lessened restrictions were associated with people remaining in care for a longer period time. This is a really important finding in support of these policy changes.”

“Prevention Point Philadelphia adapted quickly during the pandemic to care for clients by shifting from only offering onsite treatment at one of their locations to offering telemedicine visits with a provider,” Ward said. “This included allowing clients to come onsite to access telemedicine appointments if they did not have access to a smartphone or computer.”

“During the course of the pandemic, people are still having massive problems accessing care for substance use disorders,” said study co-author Benjamin Cocchiaro, MD, a family medicine provider at Prevention Point. “We’re now allowed to do telemedicine visits, space out urine drug screens — bringing down these barriers brought our internal follow-up rates from one out of five people staying for 180 days up to about three out of five people.”

Buprenorphine helps people recovering from opioid use disorder by reducing cravings and withdrawal symptoms, cutting risk of fatal overdose in half during the first six months of treatment. The medication is prescribed and monitored under the direction of a medical professional to help strengthen recovery from substance use disorder.

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