Abstract

Objective: To describe the adaptations made in office-based opioid treatment settings in response to the COVID-19 pandemic.
Methods: A survey was distributed to 202 staff from 95 primary care clinics across the state of California. The response rate was 67 individuals (33.2%) from 41 clinics (43.2%). The survey inquired about changes in service delivery for patients with opioid use disorder (OUD) between April 21 and May 8, 2020. Data on active OUD patient panel size, patients with a new medication for OUD (MOUD) prescription or refill within the past 90 days, were collected through staff submitted monthly reports between January and August 2020.
Results: 39 of 41 clinics (95.1%) reported making adaptations to OUD patient practices during the pandemic. In general, clinics transitioned from in-person to virtual care for initial (39.0%) and follow-up (46.3%) medication visits. Similarly, behavioral health visits shifted from in-person to virtual care for initiation (29.2%) and follow-up (43.9%) appointments. Most of the clinics reduced the frequency of administering toxicology monitoring (70.7%). Remarkably, the number of active OUD patients increased by 9.3% between January and August of 2020.
Conclusion: This study demonstrated that many primary care clinics implemented adaptations in response to COVID-19
regulatory changes, including virtual visits, reduced toxicology screens while increasing the active MOUD patient panel size. Although these adaptations indicate continued or improved access to care, further evaluation is needed to determine the impact of these adaptations, as well as suggestions for their sustainment on quality of care and patient outcomes.

Keywords: COVID-19; Opioid use disorder; Telehealth; Primary care; Medications for opioid use disorder; Behavioral health; Urine toxicology screening