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A recent AHRQ article provides a brief recap on the synergistic effects of the COVID-19 pandemic and the opioid crisis. Among this recap includes Findings of an NIH analysis of electronic health records that show people with substance use disorder (SUD), including those with opioid use disorder (OUD), are more vulnerable to the coronavirus than individuals without SUD and those with SUD are more likely to both develop COVID-19 and experience worse outcomes (e.g., hospitalization and death).

In a recent survey of primary care clinicians, one-third of respondents reported an increase in patients with substance use disorder during the COVID-19 pandemic. Preliminary data indicate the rate of overdose deaths involving opioids increased nationally during the first few months of the COVID-19 pandemic, and modeling suggests opioid overdose rates will remain elevated long after physical distancing orders end. It is essential to ensure treatment for opioid use disorder (OUD) is accessible during and after physical distancing precautions.

A recent JAMA Network article warns of the “synergistic effects” of the COVID-19 pandemic and the opioid epidemic and how those effects will exacerbate existing health disparities. Some social determinants of health and factors that play a role in those (e.g., racism, discrimination, poverty, lack of access to quality healthcare) contribute to both increased risk of substance use and overdose, and to preexisting chronic conditions that increase risk of poor COVID-19 outcomes.

The Agency for Healthcare Research and Quality commissioned a rapid evidence review (1.6MB) on the effectiveness of interventions, to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD). The study team searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). They summarized evidence for six retention intervention types and reported the following key findings from 2 SRs and 39 primary studies:

• Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release.
• Contingency management improved retention when combined with antagonist MAT but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges.
• Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches.
• Early studies suggest no difference in retention with XR-buprenorphine in either injectable or implant formulations compared with daily buprenorphine. Studies showed conflicting results with XR-naltrexone injection compared with daily buprenorphine.
• The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness.

During late June 2020, 40 percent of U.S. adults reported struggling with mental health or substance use issues. Among those experiencing disproportionately worse behavioral health outcomes were racial and ethnic minorities, younger adults, essential workers, and unpaid adult caregivers.

A recent Study from from the Centers for Disease Control and Prevention, found that intervention and prevention efforts to address COVID-19-associated behavioral health conditions should be part of the public health response to the pandemic. Community-level efforts, including communication strategies, should target those at increased risk for psychological distress and unhealthy coping mechanisms.

The Forum on Mental Health and Substance Use Disorders of the National Academies of Science, Engineering, and Medicine (NASEM) hosted a virtual public workshop on primary care approaches to delivering essential components of care for people with mental health and substance use disorders. Due to COVID-19, the workshop was held virtually via webinars on June 3, July 29, and August 26, 2020. Among the workshop presenters were two members of the National Integration Academy Council (NIAC), Frank Verloin deGruy III, M.D., MSFM, Chair; and Parinda Khatri, Ph.D. These experts, along with the many others who participated, provided an excellent overview of how far integrated behavioral health in primary care has come. They also addressed pitfalls and obstacles that need to be addressed and suggested strategies for going forward.

The Forum on Mental and Substance Use Disorders was convened by NASEM’s Health and Medicine Division. Information on the workshop, as well as links to all associated materials, including videos of the webinars, and the report are available.

As part of healthcare transformation in response to the COVID-19 pandemic, telehealth has greatly expanded. Many see this rapid expansion of telehealth not only as a solution to the current problem, but also as “an innovation whose time has come.” Rapid legislative and regulatory changes to payment and privacy requirements have been implemented. Of particular note are the Centers for Medicare & Medicaid Services temporary waivers and new rules that expanded access to care and facilitated payment for a wider range of telehealth services, including various behavioral health services. Changes in State policy and payment have also been important to expanding the delivery of behavioral health care via telehealth.

AHRQ has produced a white paper commentary summarizing the evidence from AHRQ-funded reports on telehealth published in 2016 and 2019. This commentary identifies two high-level findings:

• Telehealth is beneficial for specific uses and patient populations, and
• The evidence of benefit was concentrated in specific uses.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a guide to support healthcare providers, systems, and communities seeking to treat stimulant use disorders. The guide describes relevant research findings, examines best practices, identifies knowledge gaps and implementation challenges, and offers useful resources with the goal of distilling this research into recommendations for practice.

Join the HRSA Center of Excellence for Behavioral Health Technical Assistance (COE for BHTA) for a webinar on medication-assisted treatment (MAT) for opioid use disorder (OUD) during COVID-19 and how the AHRQ Academy Playbook can support this work. Presenters will share:

• Tips and strategies that health centers can use at each stage of implementation
• Emerging treatment models
• Technologies and challenges of managing poly-substance use
• Resources included in the AHRQ Academy Playbook
• A case study from a health center in Maine (Penobscot Community Health Care).

Register for this webinar today - new users will need to first create an account. HRSA-funded Federally Qualified Health Centers, Primary Care Associations, Health Center Controlled Networks, and National Training and Technical Assistance Partners, as well as health center look-alikes, are invited to register for this webinar.

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), recently awarded $20.3 million to 44 recipients, to train addiction specialists at facilities in high-need communities that integrate behavioral and primary care services. HRSA’s Addiction Medicine Fellowship (AMF) program builds on the Agency’s efforts to combat the opioid crisis, and the new AMF program will increase the number of fellows these programs can train.

For a list of June 2020 award recipients, visit https://bhw.hrsa.gov/grants/medicine/addiction/fellowship-awards-fy20

A recent commentary in the Annals of Internal Medicine addresses the negative physical and psychological effects of the COVID-19 pandemic on healthcare workers (HCWs). The authors share lessons learned from observations of HCWs during the SARS and H1N1 outbreaks and summarize possible best practices to help reduce adverse effects for HCWs and promote institutional resilience.

Check out three new AHRQ-funded reports that assess the effectiveness and harm of different kinds of chronic pain treatments. These systematic reviews present the current state of the science on treatments for the most common types of chronic pain.

Register for an upcoming webinar series beginning on June 3 hosted by The National Academies of Sciences, Engineering, and Medicine. The first webinar will explore the landscape of evolving models of care, such as accountable care organizations, patient-centered medical homes, and collaborative care arrangements. The second webinar, will feature our very own Academy NIAC member Dr. Frank deGruy Dr. deGruy will highlight approaches to facilitate the delivery of essential components of care for people with mental health and substance use disorders in primary care settings.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued tips on how to maintain your mental health and support yourself and loved ones during social distancing, quarantine, and isolation. You can also find additional resources for help during this crisis:
https://integrationacademy.ahrq.gov/news-and-events/resources/covid-19-a...

Did you know that people who use drugs are at higher risk of getting COVID-19 because of their weakened immune system? The Yale University School of Medicine has released Guidance for People Who Use Substances on COVID-19. Take a look. This resource emphasizes that harm reduction can help individuals reduce their risk of getting sick, and provides helpful tips for planning ahead.
https://integrationacademy.ahrq.gov/news-and-events/resources/covid-19-h...

Visit the Academy portal homepage and access the latest resources for COVID-19 and its impact on behavioral health and primary care.

The AHRQ Academy has developed “6 Tips from the MAT for OUD Playbook,” a downloadable PDF infographic with a list of tips on things to avoid when implementing MAT for OUD services in primary care settings. Access the tip sheet here: https://integrationacademy.ahrq.gov/sites/default/files/ahrq-whatnottodo...

The AHRQ Academy has developed the MAT tools and Resources a searchable database of tools and resources available to help those who offer or use MAT services. The tools can be filtered by a number of factors, including use, topic, format, audience, and terms of use. These tools can be used for opioid use disorder awareness and education, prevention of opioid use disorder, training and education about MAT, and implementation of MAT in Ambulatory Care. The tools and resources were identified through systematic searches within various published and grey literature. Although these tools are not specifically designed for rural primary care practice, they can be used in those settings, as well as a variety of other settings. Browse through the current collection and use the different filters and features to further specify your search.
https://integrationacademy.ahrq.gov/products/opioid-substance-use-resour...

Since 2010, HRSA has hosted National Rural Health Day to highlight the efforts of and collaborations in rural communities to address unique challenges in accessing and delivering healthcare services. On November 21, join HRSA, U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan, and other HHS agencies for a special celebration via webcast.

Visit the Academy Portal to learn more about National Rural Health Day events. https://integrationacademy.ahrq.gov/news-and-events/news/participate-nat...

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