Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review.
Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review.
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DOI：
10.1186/s13722-021-00275-1
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发表时间：
2021-11-13
影响因子：
3.7
通讯作者：
Tofighi B
中科院分区：
文献类型：
--
作者：
Krawczyk N;Fawole A;Yang J;Tofighi B
COVID-19大流行对阿片类药物使用者的生命造成了重大影响。与此同时，围绕提供阿片类药物使用障碍（OUD）服务的更灵活的法规为促进PWUO获得服务带来了新的机会。在目前的范围审查，我们描述了新的服务和服务修改实施的治疗和减少伤害的计划服务PWUO，并讨论了政策和实践的影响。在PubMed、LitCovid、Embase和PsycInfo中对2020年发表的英语研究进行了文献检索，这些研究描述了旨在促进在COVID-19大流行期间获得OUD治疗和/或减少伤害服务的特定计划、服务或干预措施。摘要由两名评审员独立筛选。对相关研究进行了全面审查，对符合纳入标准的研究进行了最终数据提取和合成（n = 25）。我们使用了叙事合成的方法，以确定围绕关键的服务修改和创新实施跨服务PWUO计划的主要主题。审查的OUD治疗和减少伤害服务跨越五大洲和一系列设置从物质使用治疗到街头推广计划。为适应COVID-19情况而进行的创新服务修改主要涉及扩大远程医疗服务的使用（例如，丁丙诺啡的远程医疗访问、虚拟个人或团体治疗会议、提供捐赠或公开电话），增加美沙酮和丁丙诺啡的带回家的药物津贴，扩大长效类阿片药物的使用（例如缓释丁丙诺啡和纳洛酮）、上门服务（例如MOUD、纳洛酮和尿液药物筛查）、提供MOUD和纳洛酮的外联和临时服务，以及提供阿片类药物的安全供应。COVID-19大流行为PWUO带来了多重挑战，同时加快了政策、护理模式和技术的创新，以降低救生治疗和减少伤害服务的门槛。这些创新突出了以患者为中心的新型可行方法，以减轻OUD相关伤害。需要进一步的研究来评估这些方法的长期影响，并为改善PWUO获得护理的政策提供信息。
The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.
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