TY - JOUR
KW - Ambulatory Care Facilities
KW - Analgesics, Opioid
KW - COVID-19
KW - Canada
KW - Cross-Sectional Studies
KW - Financing, Personal
KW - Health services
KW - Health Services Accessibility
KW - Insurance, Health
KW - Medicaid
KW - Methadone/therapeutic use
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/therapy
KW - Pandemics
KW - United States
KW - Waiting Lists
AU - P. J. Joudrey
AU - Z. M. Adams
AU - P. Bach
AU - S. Van Buren
AU - J. A. Chaiton
AU - L. Ehrenfeld
AU - M. E. Guerra
AU - B. Gleeson
AU - S. D. Kimmel
AU - A. Medley
AU - W. Mekideche
AU - M. Paquet
AU - M. Sung
AU - M. Wang
AU - R. O. O. You Kheang
AU - J. Zhang
AU - E. A. Wang
AU - E. J. Edelman
A1 - 
AB - IMPORTANCE: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. OBJECTIVE: To compare timely access to methadone initiation in the US and Canada during COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. EXPOSURES: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). MAIN OUTCOMES AND MEASURES: Proportion of clinics accepting new patients and days to first appointment. RESULTS: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.
AD - Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; British Columbia Center on Substance Use, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.; Yale School of Nursing, Orange, Connecticut.; British Columbia Center on Substance Use, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.; Yale School of Nursing, Orange, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Vassar College, Poughkeepsie, New York.; Sections of General Internal Medicine and Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.; Yale School of Nursing, Orange, Connecticut.; Faculty of Pharmacy, Université de Montréal, Montréal, Canada.; Faculty of Pharmacy, Université de Montréal, Montréal, Canada.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; VA Connecticut Healthcare System, West Haven.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Faculty of Pharmacy, Université de Montréal, Montréal, Canada.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut.
BT - JAMA network open
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities
CP - 7
DO - 10.1001/jamanetworkopen.2021.18223
IS - 7
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. OBJECTIVE: To compare timely access to methadone initiation in the US and Canada during COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. EXPOSURES: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). MAIN OUTCOMES AND MEASURES: Proportion of clinics accepting new patients and days to first appointment. RESULTS: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.
PY - 2021
SN - 2574-3805; 2574-3805
T1 - Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada
T2 - JAMA network open
TI - Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities
U2 - 34297070
U3 - 10.1001/jamanetworkopen.2021.18223
VL - 4
VO - 2574-3805; 2574-3805
Y1 - 2021
Y2 - Jul 1
ER -