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- Title
Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada.
- Authors
Joudrey, Paul J.; Adams, Zoe M.; Bach, Paxton; Van Buren, Sarah; Chaiton, Jessica A.; Ehrenfeld, Lucy; Guerra, Mary Elizabeth; Gleeson, Brynna; Kimmel, Simeon D.; Medley, Ashley; Mekideche, Wassim; Paquet, Maxime; Sung, Minhee; Wang, Melinda; You Kheang, R. O. Olivier; Zhang, Jingxian; Wang, Emily A.; Edelman, E. Jennifer
- Abstract
Key Points: Question: How does timely methadone access for opioid use disorder compare between the US and Canada during COVID-19? Findings: In this cross-sectional study of methadone clinics during COVID-19 in 13 US states and the District of Columbia and 3 Canadian provinces with the highest rates of opioid overdose deaths, more than 1 in 10 clinics were not accepting patients, one-third of which reported this was due to COVID-19. Canadian clinics offered appointments faster than US clinics. Meaning: These findings suggest that methadone access may be worse than previously estimated and exacerbated by COVID-19 and that Canadian clinics may provide timelier access than US opioid treatment programs. This cross-sectional study examines the proportion of clinics accepting new patients with opioid use disorder and time until first appointment in the US and Canada. Importance: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. Objective: To compare timely access to methadone initiation in the US and Canada during COVID-19. Design, Setting, and Participants: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Exposures: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Main Outcomes and Measures: Proportion of clinics accepting new patients and days to first appointment. Results: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P <.001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. Conclusions and Relevance: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.
- Subjects
CANADA; UNITED States; METHADONE treatment programs; NARCOTICS; SUBSTANCE abuse; CONFIDENCE intervals; ANALGESICS; CROSS-sectional method; DRUG overdose; CLINICS; MEDICAL care; HEALTH insurance; DESCRIPTIVE statistics; MEDICAID; MEDICAL appointments; COVID-19 pandemic
- Publication
JAMA Network Open, 2021, Vol 4, Issue 7, pe2118223
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.18223