Scope and impact of methadone take-home and telehealth practice changes during the COVID-19 pandemic

COVID-19 大流行期间美沙酮带回家和远程医疗实践变化的范围和影响

基本信息

  • 批准号:
    10539988
  • 负责人:
  • 金额:
    $ 53.78万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2022
  • 资助国家:
    美国
  • 起止时间:
    2022-09-30 至 2026-06-30
  • 项目状态:
    未结题

项目摘要

Abstract Methadone is an effective treatment for opioid use disorder (OUD) that is delivered in the U.S. through specialized Opioid Treatment Programs (OTPs). Since the inception of the OTP system many decades ago, federal regulations have required frequent clinic attendance to monitor patients’ response to treatment and reduce the risks of methadone diversion. Patients can only ‘earn’ take-home methadone after significant time in treatment while demonstrating rigid standards for adherence and stability. However, these classic regulations are not grounded in strong empirical evidence. The COVID-19 pandemic transformed service delivery practices at OTPs. To reduce crowding in clinics, SAMHSA regulators swiftly issued regulatory exemptions that gave OTPs unprecedented discretion to provide take-home methadone doses and deliver counseling via telehealth. OTPs were suddenly permitted to dispense up to 14 days of take-home methadone for ‘less stable’ patients, and 28 days for ‘stable’ patients. More recently, SAMHSA reaffirmed the regulatory exemptions and announced intentions to pursue permanent regulatory reform for OTPs. However, research is needed to examine the scope and impact of these major changes to care delivery. This study will (1) characterize practice changes at OTPs following the COVID-19 pandemic and the issuance of regulatory exemptions, (2) Examine the relationship of two major practice changes (expanded take-home methadone and telehealth practices) and patient outcomes, (3) develop a prediction model to inform decision- making about when patients can safely receive take-homes without increasing risk of negative outcomes, and (4) examine the relationship between expanded take-home methadone and methadone overdose deaths at a population level. The study will use clinical and administrative data from BayMark Health Services, the largest provider of outpatient OUD treatment in the U.S., with 100 OTPs in 23 states. Advanced analytical methods will be applied to answer the research questions, including multilevel generalized linear mixed modeling, predictive modeling and simulation methods, and interrupted time series. All analyses will consider behavioral health equity and examine disparities with respect to patients’ sex, race, and ethnicity. This study will provide critical data for regulators, OTP administrators, and practitioners. It will yield highly novel data to support evidence-driven regulatory reform, and could shape methadone treatment delivery over the next decade and beyond. The COVID-19 pandemic and associated federal exemptions offer an unprecedented opportunity to evaluate long-held assumptions about how methadone treatment should be structured to maximize its benefits while safeguarding patients and the public from unintended harm.
摘要

项目成果

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Jan Gryczynski其他文献

Jan Gryczynski的其他文献

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{{ truncateString('Jan Gryczynski', 18)}}的其他基金

Scope and impact of methadone take-home and telehealth practice changes during the COVID-19 pandemic
COVID-19 大流行期间美沙酮带回家和远程医疗实践变化的范围和影响
  • 批准号:
    10705259
  • 财政年份:
    2022
  • 资助金额:
    $ 53.78万
  • 项目类别:
Opioid Use Disorder Treatment Linkage at STD Clinics using Buprenorphine (OUTLAST-B)
在 STD 诊所使用丁丙诺啡治疗阿片类药物使用障碍治疗联动 (OUTLAST-B)
  • 批准号:
    9905496
  • 财政年份:
    2019
  • 资助金额:
    $ 53.78万
  • 项目类别:
Opioid Use Disorder Treatment Linkage at STD Clinics using Buprenorphine (OUTLAST-B)
在 STD 诊所使用丁丙诺啡治疗阿片类药物使用障碍治疗联动 (OUTLAST-B)
  • 批准号:
    10348119
  • 财政年份:
    2019
  • 资助金额:
    $ 53.78万
  • 项目类别:
People Preferring Fentanyl (PPF): Characteristics, Outcomes, and Perspectives
人们偏好芬太尼 (PPF):特征、结果和前景
  • 批准号:
    9973245
  • 财政年份:
    2019
  • 资助金额:
    $ 53.78万
  • 项目类别:
Navigation Services to Avoid Rehospitalization (NavSTAR) among substance abusers
为药物滥用者提供避免再住院的导航服务 (NavSTAR)
  • 批准号:
    9220776
  • 财政年份:
    2015
  • 资助金额:
    $ 53.78万
  • 项目类别:
A randomized clinical trial of SBIRT services in school-based health centers
学校健康中心 SBIRT 服务的随机临床试验
  • 批准号:
    9262891
  • 财政年份:
    2014
  • 资助金额:
    $ 53.78万
  • 项目类别:
A randomized clinical trial of SBIRT services in school-based health centers
学校健康中心 SBIRT 服务的随机临床试验
  • 批准号:
    8845183
  • 财政年份:
    2014
  • 资助金额:
    $ 53.78万
  • 项目类别:

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