Medication-Assisted Treatment (MAT) During The Coronavirus Pandemic

Explore how medication-assisted treatment during COVID-19 adapts, ensuring recovery isn't paused.

Published On

April 26, 2024

Dove Recovery's Team

Medication-Assisted Treatment (MAT) During The Coronavirus Pandemic

Medication-Assisted Treatment (MAT) Overview

Medication-Assisted Treatment (MAT) is a significant component of the response to the opioid crisis, particularly during the COVID-19 pandemic. It is vital to understand what MAT entails and why it is crucial in these challenging times.

Understanding MAT

Medication-Assisted Treatment (MAT) is a comprehensive approach to treating Opioid Use Disorder (OUD). The Food and Drug Administration has approved three medications for this purpose: methadone, buprenorphine, and naltrexone. These medications are used in conjunction with other treatments depending on individual needs and circumstances, to enhance the health and wellbeing of individuals with OUD.

Methadone and buprenorphine, unlike many illicit opioids, have a stabilizing effect that helps break the cycle of craving and withdrawal in individuals with OUD. These medications are beneficial in MAT, as studies show that individuals with OUD prescribed methadone or buprenorphine are 50% less likely to die from an overdose compared to no treatment or those taking naltrexone. Methadone and buprenorphine, as opioids, reduce cravings and withdrawal symptoms while maintaining opioid tolerance to reduce the risk of death upon a return to illicit use.

Importance of MAT during COVID-19

Access to Medication-Assisted Treatment (MAT) is crucial, especially during the COVID-19 pandemic. Demand for MAT, particularly with methadone and buprenorphine, exceeds availability in the U.S., leading to long wait times, insurance barriers, and even deaths among those waiting for treatment. Lack of access to MOUD can result in diversion and misuse of prescription drugs, posing risks to communities and institutions. Moreover, discrimination against individuals receiving treatment for OUD is considered an infringement of the Americans with Disabilities Act (ADA), which could lead to legal action against various entities [1].

The pandemic has forced changes to MAT practices, including a transition to telehealth services and changes in prescription practices. The Substance Abuse and Mental Health Services Administration (SAMHSA) issued an exemption to Opioid Treatment Programs (OTPs) on March 16, 2020, allowing stable patients to receive up to 28 days of take-home doses of medication for opioid use disorder. This exemption has resulted in increased treatment engagement, improved patient satisfaction with care, and relatively few incidents of misuse or medication diversion [2].

Understanding the role and importance of MAT in the context of the COVID-19 pandemic is crucial, as it is a key part of the strategy to address the opioid crisis while navigating the challenges posed by the pandemic.

Medication Options for MAT during the Pandemic

During the COVID-19 pandemic, the need for effective and accessible medication-assisted treatment (MAT) options has been more critical than ever. The Food and Drug Administration has approved three medications - methadone, buprenorphine, and naltrexone - for treating Opioid Use Disorder (OUD) through MAT [1]. Each of these medications has unique qualities and impacts, and understanding them is essential for effective MAT.

Methadone Treatment

Methadone is an opioid medication used in MAT to help individuals reduce or quit their use of heroin or other opiates. It works by changing how the brain and nervous system respond to pain. Methadone and buprenorphine, unlike many illicit opioids, have a stabilizing effect that helps break the cycle of craving and withdrawal in individuals with OUD, making them beneficial for MAT. These medications can be used in conjunction with various other treatments depending on individual needs and circumstances.

Studies show that individuals with OUD prescribed methadone or buprenorphine are 50% less likely to die from an overdose compared to no treatment or those taking naltrexone. Methadone and buprenorphine, as opioids, reduce cravings and withdrawal symptoms while maintaining opioid tolerance to reduce the risk of death upon a return to illicit use.

During the pandemic, SAMHSA issued an exemption allowing Opioid Treatment Programs (OTPs) to provide up to 28 days of take-home doses of medication for stable patients and up to 14 days for less stable patients.

Buprenorphine Treatment

Buprenorphine is a partial opioid agonist that helps control withdrawal symptoms and cravings. It is often used in combination with other medications and therapies to provide a comprehensive MAT approach. Just like methadone, buprenorphine also has a stabilizing effect on individuals with OUD, reducing cravings and withdrawal symptoms while maintaining opioid tolerance [1].

Importantly, SAMHSA's exemptions during the pandemic have also applied to buprenorphine, allowing for increased accessibility and flexibility in treatment, particularly through take-home doses for stable and less stable patients.

Naltrexone Treatment

Naltrexone, another medication used in MAT, works differently than methadone and buprenorphine. It is an opioid antagonist that blocks the effects of opioids, thereby reducing cravings. However, evidence suggests that naltrexone has been linked to an increased risk of overdose in individuals using it to treat OUD. In fact, those taking naltrexone are more likely to drop out of treatment in the initial 30 days compared to individuals using buprenorphine.

Overall, these medication options for MAT during the pandemic have played a crucial role in providing effective treatment for individuals with OUD. The choice of medication should be based on an individual's specific needs and circumstances, considering the unique properties and impacts of each medication. SAMHSA's exemptions have significantly increased access to these medications, making MAT more adaptable and accessible during these challenging times.

Impacts of COVID-19 on MAT Practices

The COVID-19 pandemic has significantly impacted various aspects of healthcare, including the practice of Medication-Assisted Treatment (MAT). This section will discuss how these practices have transitioned to telehealth, changes in prescription practices, and modifications to patient-centered care.

Transition to Telehealth

One of the most notable changes in the delivery of MAT during the pandemic has been the transition to telehealth. This shift was largely driven by the need to maintain social distancing measures and reduce the risk of COVID-19 transmission. Telemedicine usage and healthcare coverage were associated with significantly higher odds of being able to obtain medication for opioid use disorder (MOUD) in the past four weeks.

Moreover, telemedicine for MOUD predicted lower illicit opioid use, greater patient retention, higher patient satisfaction, and overall better treatment outcomes. Telemedicine may effectively address barriers to care that patients may face, such as lack of specialized providers and transportation.

Changes in Prescription Practices

The pandemic has also influenced prescription practices for MOUD. Federal regulators waived the requirement for in-office visits for MOUD prescription receipt and provided guidance on increasing third-party payer reimbursement rates for telehealth visits to mitigate barriers to care associated with COVID-19 safety guidelines.

Providers expressed support for making temporary regulatory flexibilities, such as increased take-home methadone supply and remote initial evaluations, permanent. They believed these flexibilities improved treatment access and allowed for more flexible, individually tailored patient care.

Patient-Centered Care Modifications

In response to the pandemic, modifications were made to MOUD treatment practices to enhance the ability to provide patient-centered care. These changes included a shift from in-person care to telehealth, reduction in the frequency of toxicology testing and counseling services, and modifications to prescription durations and take-home methadone supplies [5].

These modifications were positively received by providers and patients alike. They not only improved access to care, but also reduced barriers for patients and allowed for more frequent patient contact [5].

The COVID-19 pandemic has undeniably brought challenges to the delivery of MAT, but it has also paved the way for innovative approaches to care. These changes have demonstrated the potential of telehealth and flexible prescription practices in enhancing the delivery of medication-assisted treatment during covid-19 and beyond.

Access to MAT during the Pandemic

The COVID-19 pandemic instigated a monumental shift in the delivery of healthcare services, including medication-assisted treatment (MAT). To ensure patients maintained access to crucial treatments, several adaptations were made in terms of service delivery, regulatory flexibilities, and patient engagement.

Telehealth for MAT Access

Amidst the pandemic, telemedicine emerged as a critical tool to maintain access to MAT. According to a survey sample of individuals who used illicit opioids, one in two individuals who utilized telehealth were able to access medications for opioid use disorder (MOUD), as compared to only one in five who did not have telehealth access. The study provides empirical evidence linking telemedicine usage to MOUD access during the early phase of the COVID-19 pandemic.

Furthermore, telemedicine for MOUD predicted lower illicit opioid use, greater patient retention, higher patient satisfaction, and overall better treatment outcomes. Telemedicine effectively addressed barriers to care that patients might face, such as lack of specialized providers and transportation.

Regulatory Flexibilities for MAT

To mitigate barriers to care associated with COVID-19 safety guidelines, federal regulators waived the requirement for in-office visits for MOUD prescription receipt and provided guidance on increasing third-party payer reimbursement rates for telehealth visits [4].

Moreover, providers expressed support for making temporary regulatory flexibilities, such as increased take-home methadone supply and remote initial evaluations, permanent. They believed these flexibilities improved treatment access and allowed for more flexible, individually tailored patient care.

Patient Satisfaction and Engagement

The shift to telehealth and other regulatory adjustments were positively received by patients. The use of telehealth for MOUD treatment improved access to care, reduced barriers for patients, and allowed for more frequent patient contact.

These changes in the delivery of MOUD, including the reduction in frequency of toxicology testing and counseling services and modifications to prescription durations and take-home methadone supplies, were perceived as enhancements to the provision of patient-centered care.

In conclusion, the COVID-19 pandemic has underscored the potential of telehealth and regulatory flexibility to enhance access to medication-assisted treatment during challenging circumstances. These adaptations have not only ensured continued access to vital treatments but also paved the way for a more flexible, patient-centered approach to care in the future.

SAMHSA Guidelines and Exemptions

The Substance Abuse and Mental Health Services Administration (SAMHSA) has played a pivotal role in modifying guidelines and providing exemptions to meet the changing needs of patients and healthcare providers during the COVID-19 pandemic. Specifically, SAMHSA's actions have significantly impacted Opioid Treatment Programs (OTPs) and the provision of medication-assisted treatment.

SAMHSA's Exemptions for OTPs

On March 16, 2020, SAMHSA issued an exemption to OTPs, allowing stable patients to receive up to 28 days of take-home doses of medication for opioid use disorder. For less stable patients, the exemption allowed for up to 14 days of take-home doses. This exemption has resulted in increased treatment engagement, improved patient satisfaction with care, and relatively few incidents of misuse or medication diversion. SAMHSA

Patient Stability	Maximum Take-Home Doses
Stable Patients	Up to 28 days
Less Stable Patients	Up to 14 days

The practitioner at the OTP determines the number of take-home doses for patients, but the allowable range after two weeks of treatment is up to a maximum of 14 doses. After 90 days, the number of take-home doses may be increased up to a maximum of 28 doses. SAMHSA

Methadone Take-Home Flexibilities

The Methadone Take-Home Flexibilities Extension Guidance, published by SAMHSA in November 2021, allows OTPs to provide unsupervised take-home doses of methadone. This guidance will be effective for one year from the end of the COVID-19 Public Health Emergency, or until final rules revising 42 C.F.R part 8 are published by the U.S. Department of Health and Human Services, whichever occurs sooner. SAMHSA

Proposed Updates for MAT Expansion

SAMHSA's proposed updates aim to make COVID-19-timed medication flexibilities, including the provision of take-home doses of methadone and telehealth for initiating buprenorphine, permanent. This will continue supporting recovery and expanding access to care for opioid use disorder. Proposed changes include updating opioid treatment program (OTP) admission criteria, such as removing the one-year requirement for opioid addiction before admission to an OTP. SAMHSA

In summary, SAMHSA's guidelines and exemptions have been instrumental in ensuring continuity of care for patients undergoing medication-assisted treatment during covid-19. The proposed updates, if implemented, are likely to further improve access to care and patient outcomes.

Healthcare Adaptations during the Pandemic

In response to the challenges imposed by the COVID-19 pandemic, healthcare systems worldwide had to adapt quickly, including those providing medication-assisted treatment. These adaptations were essential in ensuring the continuous and effective delivery of healthcare services.

Healthcare System Changes

The pandemic necessitated significant changes in healthcare systems. These included alternative ways of triaging and assessing patient needs, reorganization of physical spaces to reduce the risk of infection, and the rapid adoption of technology to provide healthcare services. In particular, digital tools such as telemedicine and videoconferencing were used to continue patient treatment and support patient care teams. These changes were crucial in maintaining medication-assisted treatment during COVID-19.

However, it's important to note that while some of these adaptations were beneficial for future organizational healthcare service changes, others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations.

Role Transformations

Healthcare professionals took on new and expanded roles during the pandemic. They engaged in educational roles, provided comfort to end-of-life patients, and filled in for absent relatives among other duties. They also had to handle unfamiliar tasks and adapt to changes in their work tasks and workflow.

The increased workload and changed work scope were consequences of rising patient numbers, reduced staff, and the absence of new hires to reflect the increased workload. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies, and healthcare services.

Digital Solutions Integration

The COVID-19 pandemic created an opportunity for healthcare systems to introduce changes and innovations that were previously thought impossible. For instance, the introduction of telemedicine, new care models, new procedures, and new working models.

Digital solutions, in particular, have played a crucial role in the delivery of medication-assisted treatment during COVID-19. They've allowed healthcare professionals to provide essential services without risking exposure to the virus. However, some adaptations made during the pandemic were short-term solutions and may have had negative impacts on the healthcare system and healthcare professionals [6].

In conclusion, while the adaptations made during the pandemic were necessary, it's essential for healthcare systems to analyze their effectiveness and impact. This will ensure that future responses to similar crises are more effective and less disruptive to the delivery of critical services, such as medication-assisted treatment.