Cook Ryan R, Blalock Kendra L, El Ibrahimi Sanae, Hoffman Kim, Levander Ximena A, Little Kacey, Leichtling Gillian, Korthuis P Todd, McCarty Dennis
Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
Comagine Health, Portland, OR, USA.
J Gen Intern Med. 2025 Feb 25. doi: 10.1007/s11606-025-09444-3.
The COVID-19 pandemic spurred relaxation of opioid treatment program (OTP) in-person daily dosing requirements. This policy change was met with widespread enthusiasm by patients and providers and did not increase illicit opioid use, overdose, or medication diversion. However, it is not known whether the policy change was effective at mitigating the COVID-19 public health emergency among people with opioid use disorder (OUD) receiving treatment at OTPs.
To evaluate the impact of treatment at OTPs on rates of COVID-19 infections and complications.
Prospective cohort from 4/1/2020 to 3/31/2021.
Oregon Medicaid beneficiaries with an OUD diagnosis.
The exposure was time-varying treatment for OUD, including (1) medication treatment at an OTP, (2) office-based opioid medication treatment (OBOT), (3) other treatment without medications for OUD, or (4) no treatment. Outcomes were COVID-19 diagnoses, COVID-related emergency department visits, and COVID-related hospitalizations.
Participants (N = 24,654) averaged 39 years old, most were female (53%), White (84%), and non-Hispanic (88%). Adjusted for characteristics and comorbidities, OTP patients demonstrated significantly reduced risk of COVID-19 diagnoses compared to all other groups: a 37% reduction compared to OBOT, a 52% reduction compared to non-MOUD treatment, and a 37% reduction compared to no OUD treatment. OTP treatment was also associated with a 40% risk reduction of COVID-related ED visits compared to OBOT, a 56% reduction compared to non-MOUD treatment, and a 46% risk reduction compared to no treatment. For inpatient stays, there was not a significant difference between OTP and OBOT treatment or no treatment, but OTP treatment was associated with a 64% risk reduction compared to non-MOUD treatment.
Lower risks of COVID-19 diagnoses and complications were observed among people with OUD receiving treatment at OTPs compared to other forms of treatment or no treatment.
2019冠状病毒病（COVID-19）大流行促使阿片类药物治疗项目（OTP）放松了每日亲自服药的要求。这一政策变化受到了患者和提供者的广泛欢迎，且并未增加非法阿片类药物的使用、过量用药或药物转移。然而，尚不清楚这一政策变化是否有效地缓解了在OTP接受治疗的阿片类药物使用障碍（OUD）患者中的COVID-19公共卫生紧急情况。
评估OTP治疗对COVID-19感染率和并发症的影响。
2020年4月1日至2021年3月31日的前瞻性队列研究。
俄勒冈医疗补助计划中诊断为OUD的受益人。
暴露因素为OUD的随时间变化的治疗，包括（1）在OTP进行药物治疗，（2）基于办公室的阿片类药物治疗（OBOT），（3）其他无药物的OUD治疗，或（4）未治疗。结局指标为COVID-19诊断、与COVID相关的急诊科就诊和与COVID相关的住院治疗。
参与者（N = 24,654）平均年龄39岁，大多数为女性（53%）、白人（84%）和非西班牙裔（88%）。在对特征和合并症进行调整后，与所有其他组相比，OTP患者的COVID-19诊断风险显著降低：与OBOT相比降低了37%，与非药物辅助阿片类药物治疗（MOUD）治疗相比降低了52%，与未进行OUD治疗相比降低了37%。与OBOT相比，OTP治疗还使与COVID相关的急诊科就诊风险降低了40%，与非MOUD治疗相比降低了56%，与未治疗相比风险降低了46%。对于住院治疗，OTP治疗与OBOT治疗或未治疗之间没有显著差异，但与非MOUD治疗相比，OTP治疗使风险降低了64%。
与其他形式的治疗或未治疗相比，在OTP接受治疗的OUD患者中观察到较低的COVID-19诊断和并发症风险。
