Medication treatment for opioid use disorder in the age of COVID-19: Can new regulations modify the opioid cascade?

Journal of Substance Abuse Treatment
Edward V NunesNabila El-Bassel

Abstract

The temporary loosening of regulations governing methadone and buprenorphine treatment for opioid use disorder (OUD) in the U.S., instituted to prevent the spread of COVID-19, has created an opportunity to explore the effectiveness of new models of care for people with OUD. The opioid cascade describes the current status of the treatment system, where only a fraction of people with OUD initiate effective medication treatment for OUD (MOUD), and of those only a fraction is retained in treatment. Regulatory changes-such as availability of larger take-home supplies of methadone and buprenorphine initiated via telemedicine (e.g., no initial in person visit; telemedicine buprenorphine permitted across state lines)-could modify the cascade, by reducing the burden and increasing the attractiveness, availability, and feasibility of MOUD both for people with OUD and for providers. We review examples of more liberal MOUD regimens, including the implementation of buprenorphine in France in the 1990s, primary care-based methadone in Canada, and low-threshold buprenorphine models. Research is needed to document whether new models implemented in the U.S. in the wake of COVID-19 are successful, and whether safety concerns, such as diversion a...Continue Reading

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Citations

Apr 29, 2021·The American Journal of Drug and Alcohol Abuse·Barbara Andraka-ChristouBradley D Stein
Jun 4, 2021·Journal of Pain Research·Steven J ScrivaniMichael E Schatman
Jun 8, 2021·Journal of Substance Abuse Treatment·Peter C TreitlerStephen Crystal
Sep 15, 2021·Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse·Brian ChanRoger Chou
Oct 30, 2021·Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association·Aileen G GuillenBharath Chakravarthy

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