TY - JOUR
KW - COVID-19
KW - telehealth
KW - buprenorphine
KW - low-barrier
KW - opioid use disorder
AU - N. J. Mehtani
AU - J. T. Ristau
AU - H. Snyder
AU - C. Surlyn
AU - J. Eveland
AU - S. Smith-Bernardin
AU - K. R. Knight
A1 - 
AB - BACKGROUND: COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS: We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS: Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS: ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
AD - Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA.; Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA.; Department of Family & Community Medicine, University of California, San Francisco, California, USA.; San Francisco Department of Public Health, San Francisco, California, USA.; San Francisco Department of Public Health, San Francisco, California, USA.; School of Nursing, University of California, San Francisco, California, USA.; Department of Anthropology, History, and Social Medicine, University of California, San Francisco, California, USA.
BT - Substance abuse
C5 - Opioids & Substance Use; Healthcare Disparities; HIT & Telehealth
CY - United States
DO - 10.1080/08897077.2021.1890676
JF - Substance abuse
LA - eng
M1 - Journal Article
N2 - BACKGROUND: COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS: We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS: Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS: ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
PP - United States
PY - 2021
SN - 1547-0164; 0889-7077
SP - 1
EP - 8
EP - 
T1 - COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management
T2 - Substance abuse
TI - COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management
U1 - Opioids & Substance Use; Healthcare Disparities; HIT & Telehealth
U2 - 33684331
U3 - 10.1080/08897077.2021.1890676
VO - 1547-0164; 0889-7077
Y1 - 2021
Y2 - Mar 8
ER -