Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural opioid treatment programs: A mixed methods analysis.
Treatment retention, return to use, and recovery support following COVID-19 relaxation of methadone take-home dosing in two rural opioid treatment programs: A mixed methods analysis.
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DOI：
10.1016/j.jsat.2022.108801
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发表时间：
2022-10
影响因子：
3.9
通讯作者：
McCarty, Dennis
中科院分区：
文献类型：
--
作者：
Hoffman, Kim A.;Foot, Canyon;Levander, Ximena A.;Cook, Ryan;Terashima, Javier Ponce;McIlveen, John W.;Korthuis, P. Todd;McCarty, Dennis
2020年3月，美国物质滥用和心理健康服务管理局允许阿片类药物治疗计划(OTP)放松对带回家的美沙酮的限制，并促进远程健康，以最大限度地减少对新冠肺炎的潜在接触。我们评估了与新冠肺炎相关的变化对俄勒冈州五个农村县的两个OTP中美沙酮实得剂量的影响。我们使用了一种混合方法的收敛设计。OTPS从患者的电子健康记录(EHR)中提取尿药试验(UDT)结果、带回家的美沙酮方案和治疗保留(n=2377)。一个混合效应负二项回归模型评估了新冠肺炎政策改变前后患者水平的带回家剂量的差异，以及与停止治疗和UDT阳性的关系。半结构化定性访谈(n=32)探讨了患者对增加带回家剂量和减少诊所就诊的反应，以提供量化结果的背景。在新冠肺炎后期间，从事治疗超过180w天的患者的实得剂量增加(中位数：每月8次与13次实得剂量，p=0.011)。接受治疗的天数较少的患者的带回家的数量没有增加。带回家的剂量比没有新冠肺炎政策变化的预期高出每一个百分点，与阿片类药物UDT阳性的百分比(B=−0.12，CI[−0.21，−0.04]，P=0.005)和停止治疗的概率(A OR=0.97，CI[0.95，0.99]，P=0.003)负相关。定性分析揭示了三个主题，解释了增加带回家的剂量如何支持康复：1)因责任增加而感到信任的价值；2)减少旅行时间允许增加就业和娱乐；3)减少对康复中不稳定的个人的暴露和潜在的触发因素。在临床稳定的患者中，美沙酮带回家剂量的放松与美沙酮带回家剂量的增加、保留的改善和UDT阿片类药物阳性结果的减少有关。定性的结果表明，较少的带回家的限制是可行和可取的，并且不会对安全或公共健康造成损害。
In March 2020, the Substance Abuse and Mental Health Services Administration permitted Opioid Treatment Programs (OTPs) to relax restrictions on take-home methadone and promoted telehealth to minimize potential exposures to COVID-19. We assessed the effects of COVID-19-related changes on take-home methadone dosing in two OTPs serving five rural Oregon counties. We used a mixed-methods convergent design. The OTPs extracted urine drug test (UDT) results, take-home methadone regimens, and treatment retention from the electronic health record (EHR) for patients (n = 377). A mixed-effects negative binomial regression model assessed patient-level differences in take-home doses before and after the COVID-19 policy changes and the associations with treatment discontinuation, and UDT positivity. Semi-structured qualitative interviews (n = 32) explored patient reactions to increased take-home dosing and reduced clinic visits to provide context for quantitative findings. The number of take-home doses increased in the post-COVID-19 period for patients engaged in treatment for more than 180 days (median: 8 vs 13 take-home doses per month, p = 0.011). Take-homes did not increase for patients with fewer days of treatment. Each percentage point increase in take-home dosing above what would be expected without COVID-19 policy changes was negatively associated with the percent of UDT positive for opioids (B = −0.12, CI [−0.21, −0.04], p = 0.005) and the probability of treatment discontinuation (aOR = 0.97, CI [0.95, 0.99], p = 0.003). Qualitative analysis revealed three themes explaining how increased take-home dosing supported recovery: 1) value of feeling trusted with increased responsibility; 2) reduced travel time permitted increased employment and recreation; and 3) reduced exposure to individuals less stable in recovery and potential triggers. Take-home methadone dose relaxations were associated with increased methadone take-home doses, improved retention, and decreased UDT opioid positive results among clinically stable patients. Qualitative findings suggest that fewer take-home restrictions are feasible and desirable and do not pose safety or public health harms.
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影响因子：
3.9
作者：
Harris MTH;Lambert AM;Maschke AD;Bagley SM;Walley AY;Gunn CM
通讯作者：
Gunn CM
Covid-19对在农村社区使用毒品的人们的心理健康，药物使用和过量关注的影响。
影响因子：
5.5
作者：
Stack E;Leichtling G;Larsen JE;Gray M;Pope J;Leahy JM;Gelberg L;Seaman A;Korthuis PT
通讯作者：
Korthuis PT
影响因子：
--
作者：
Moss, Eloise;McEachern, Jasmine;Klimas, Jan
通讯作者：
Klimas, Jan
DOI：
10.1176/appi.ajp.2021.20101548
发表时间：
2021-09-01
期刊：
The American journal of psychiatry
影响因子：
--
作者：
McCarty D;Bougatsos C;Chan B;Hoffman KA;Priest KC;Grusing S;Chou R
通讯作者：
Chou R
影响因子：
5.4
作者：
Lobe, Bojana;Morgan, David;Hoffman, Kim A.
通讯作者：
Hoffman, Kim A.