Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY, United States of America.
Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, NY, United States of America.
J Subst Abuse Treat. 2022 Apr;135:108641. doi: 10.1016/j.jsat.2021.108641. Epub 2021 Oct 27.
In 2020, the US and New York City experienced unprecedented deaths due to the COVID-19 pandemic and drug overdoses. Policy changes reduced burdensome regulations for medication treatment for opioid use disorder (OUD). Despite these policy changes, few studies examined buprenorphine treatment outcomes during the pandemic. We compared treatment outcomes among Bronx patients referred to office-based buprenorphine treatment before versus during the pandemic.
In a retrospective cohort study, we compared patients referred to buprenorphine treatment in a Bronx community clinic before (March-August 2019) versus during (March-August 2020) the pandemic. We describe changes to buprenorphine treatment during the pandemic, including telehealth and prioritizing harm reduction. Using data from medical records and program logs, main outcomes included steps of the OUD treatment cascade of care-initial visit scheduled and completed, treatment initiated, and retained in treatment at 90 days. Using chi square and t-tests, we examined differences in patient characteristics and OUD treatment cascade steps before versus during the pandemic.
Before and during the pandemic, 72 and 35 patients were referred to buprenorphine treatment, respectively. Patients' mean age was 46 years, most were male (67.3%) or Hispanic (52.3%), and few had private insurance (19.6%). Patients referred during (vs. before) the pandemic were more likely to have private insurance (31.4% vs. 13.9%, p < 0.05) and be referred from acute care settings (37.1% vs. 19.4%, p < 0.05). No significant differences in OUD cascade of care outcomes existed between those referred during versus before the pandemic. However, among patients who initiated buprenorphine treatment, those referred during (vs. before) the pandemic were more likely to be retained in treatment at 90 days (68.0% vs. 42.9%, p < 0.05).
Despite the COVID-19 pandemic's unprecedented devastation to the Bronx, along with worsening drug overdose deaths, OUD cascade of care outcomes were similar among patients referred to buprenorphine treatment before versus during the pandemic. Among patients who initiated buprenorphine treatment, treatment retention was better during (versus before) the pandemic. During a public health emergency, incorporating telehealth and prioritizing harm reduction are key strategies to maintain optimal OUD treatment outcomes.
2020 年，美国和纽约市经历了前所未有的 COVID-19 大流行和药物过量死亡。政策的改变减轻了阿片类药物使用障碍（OUD）药物治疗的繁琐规定。尽管政策有所改变，但很少有研究在大流行期间检查丁丙诺啡治疗的结果。我们比较了在布隆克斯接受门诊丁丙诺啡治疗的患者在大流行前（2019 年 3 月至 8 月）和大流行期间（2020 年 3 月至 8 月）的治疗结果。
在回顾性队列研究中，我们比较了在布隆克斯社区诊所接受丁丙诺啡治疗的患者，比较了大流行前（2019 年 3 月至 8 月）和大流行期间（2020 年 3 月至 8 月）的患者。我们描述了大流行期间丁丙诺啡治疗的变化，包括远程医疗和优先考虑减少伤害。使用医疗记录和项目日志中的数据，主要结果包括阿片类药物使用障碍治疗级联护理的步骤-初始就诊预约和完成、开始治疗以及在 90 天内保留治疗。使用卡方检验和 t 检验，我们比较了大流行前后患者特征和阿片类药物使用障碍治疗级联护理步骤的差异。
大流行前和大流行期间，分别有 72 名和 35 名患者被转介接受丁丙诺啡治疗。患者的平均年龄为 46 岁，大多数为男性（67.3%）或西班牙裔（52.3%），很少有私人保险（19.6%）。与大流行前相比，大流行期间被转介的患者更有可能拥有私人保险（31.4%比 13.9%，p<0.05）和来自急性护理环境（37.1%比 19.4%，p<0.05）。在接受丁丙诺啡治疗的患者中，大流行前后阿片类药物使用障碍治疗级联护理结果之间没有显著差异。然而，在开始丁丙诺啡治疗的患者中，与大流行前相比，大流行期间被转介的患者更有可能在 90 天内保留治疗（68.0%比 42.9%，p<0.05）。
尽管 COVID-19 大流行对布朗克斯造成了前所未有的破坏，以及药物过量死亡人数的增加，但在大流行前和大流行期间被转介接受丁丙诺啡治疗的患者的阿片类药物使用障碍治疗级联护理结果相似。在开始丁丙诺啡治疗的患者中，大流行期间的治疗保留率更好。在公共卫生紧急情况下，采用远程医疗和优先考虑减少伤害是维持最佳阿片类药物使用障碍治疗结果的关键策略。
