Evaluation of Low Threshold Buprenorphine Treatment in the Context of COVID-19

项目总结/摘要 丁丙诺啡是治疗阿片类药物使用障碍的循证药理学方法 （OUD）。尽管其疗效，丁丙诺啡是显着利用不足，部分原因是， 历史上对治疗进入和继续的严格要求。为了解决这个问题， 最近有人呼吁建立“低门槛”护理，以消除治疗障碍， 并改善整体访问。COVID-19大流行给中国带来了前所未有的压力， 美国的人口和医疗体系。社交距离措施现已到位， 降低病毒传播的风险。虽然这些公共卫生政策可以防止 感染COVID-19，它们也有可能破坏物质使用的治疗 疾病，特别是OUD，它严重依赖于面对面的医疗服务。在 为回应这些关注，当局已发布新指引，鼓励市民在这方面有更大的灵活性 丁丙诺啡的处方这些变化有可能增加获得 丁丙诺啡治疗OUD患者的成功，然而， 不知道与COVID-19相关的系统性变化可能如何影响 丁丙诺啡处方、治疗利用或对患者结局的影响。的目标 本研究旨在通过混合方法检验， 提供丁丙诺啡治疗和患者层面的治疗， 隶属于最大医院的三家丁丙诺啡门诊诊所的结果 在罗得岛州的系统。通过这份特别关注通知（NOSI）， 拟议的研究将捕捉和描述正在发生的时间敏感性变化， 丁丙诺啡治疗通过本研究获得的信息将 确定可能影响低阈值方法实施的关键因素， 2019冠状病毒病疫情。此外，本建议旨在从经验上评估a） 丁丙诺啡处方实践和治疗，以及B）如何改变护理的提供 影响患者水平的结果。本研究的结果可用于指导最佳实践 丁丙诺啡处方指南，以确保OUD治疗的安全性和有效性。的 本申请中概述的目标与COBRE关于阿片类药物的总体目标一致， 通过指导初级研究人员来解决阿片类药物危机， 转变为独立的临床研究人员，专注于开发和评估 循证治疗OUD。

PROJECT SUMMARY/ABSTRACT Buprenorphine is an evidence-based pharmacological approach to treating opioid use disorder (OUD). Despite its efficacy, buprenorphine is significantly underutilized, in part, because of historically rigid requirements for treatment entry and continuation. To address this concern, there have been recent calls to establish “low threshold” care to remove barriers to treatment and improve overall access. The COVID-19 pandemic has placed an unprecedented strain on the U.S. population and healthcare system. Social distancing measures are now in place to mitigate the risk of viral transmission. While these public health policies may protect against contracting COVID-19, they also have the potential to disrupt treatment for substance use disorders, particularly OUD, which relies heavily on face-to-face healthcare delivery. In response to such concerns, new guidelines have been released to encourage greater flexibility in the prescribing of buprenorphine. These changes have the potential to increase access to and success with buprenorphine treatment for individuals with OUD, however, it remains unknown how systematic changes related to COVID-19 may affect the practice of buprenorphine prescribing, treatment utilization, or impact on patient outcomes. The objective of the present study is to examine, through a mixed-method approach, the preliminary association of the COVID-19 pandemic with the provision of buprenorphine treatment and patient-level outcomes across three outpatient buprenorphine clinics affiliated with the largest hospital system in the state of Rhode Island. Through this Notice of Special Interest (NOSI), the proposed study will capture and characterize time-sensitive changes that are occurring to buprenorphine treatment as a result of COVID-19. Information obtained through this study will identify key factors that may influence implementation of a low threshold approach following the COVID-19 pandemic. Additionally, this proposal seeks to empirically evaluate a) changes to buprenorphine prescribing practices and treatment, and b) how changes to the delivery of care impact patient-level outcomes. Results of this study may be leveraged to inform best-practice guidelines for buprenorphine prescribing to ensure safety and efficacy of OUD treatment. The aims outlined within this application align with the overall objectives of COBRE on Opioids and Overdose to address the opioid crisis by mentoring junior investigators so that they may transition into independent clinical researchers focused on the development and evaluation of evidence-based treatment for OUD.