During the COVID-19 Pandemic, the United States Drug Enforcement Administration (DEA) temporarily relaxed restrictions to best serve people in treatment for substance use disorders (SUD) during social distancing mandates. Changes include allowing longer take home doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenorphine), and relaxed restrictions on telehealth prescribing and treatment. These changes directly and indirectly impact the approximately 14,500 substance use treatment programs in the United States, but the actual implementation of the changes is poorly understood. The overarching goals of the proposed project, therefore, are to: (1) document impacts of relaxed restrictions for telemedicine and mHealth; and (2) assess implementation of MAT ?take-homes? for people in SUD treatment in rural, underserved, and minority communities in Arizona in the wake of COVID-19. To accomplish these goals, we propose to use Rapid Assessment, Response and Evaluation (RARE) methods to complete the following specific aims:
AIM 1 : Identify barriers and facilitators to successful implementation of telehealth and mHealth for opioid treatment in the context of COVID- 19 restrictions, temporary guideline changes, and ?reopening stages?;
and AIM 2 : Assess implementation of medication assisted treatment guideline changes and equity in access to ?take- homes? for people in rural and underserved populations. RARE is a well-established mixed-method approach designed to gather data relevant to institutions and communities as they respond to crisis situations. RARE assessment involves triangulation of multiple methods to conduct rigorous, locally responsive assessment and evaluation within a much shorter timeframe than conventional research. We propose to use RARE methods to collect information about online care delivery program barriers and facilitators, and to provide local communities with information about local equity, acceptability, and feasibility of potential telehealth and mHealth interventions. The knowledge to be gained from the proposed project will contribute to understanding how DEA guideline changes during COVID-19 were implemented and experienced by stakeholders, providers, and patients in treatment for opioid dependence. The proposed study is expected to provide in-depth information about providers? and patients? experiences of the changes and inform the debate at the national level about whether policy guideline changes should become permanent after COVID-19 risk has lessened. There is a pressing need to document experiences of the new guidelines as policymakers decide whether to make the guidelines permanent. In-depth investigation stands to fills key gaps in understanding about whether and how increased access to medication-assisted treatment and more access to treatment via telehealth and mHealth platforms can improve equity for people in rural and underserved areas who have limited access to care for substance use disorders.
The proposed project will employ Rapid Assessment, Response and Evaluation (RARE) methods to understand how DEA guideline changes allowing increased access to methadone and buprenorphine and treatment via telemedicine during COVID-19 were implemented and experienced by stakeholders, providers, and patients in treatment for opioid dependence. Data to be collected are crucial to informing a debate at the national level about whether policy guideline changes should become permanent after COVID-19 risk has lessened. Research is needed particularly because the changes are believed to improve access to medication-assisted treatment and reduce travel burden for people in rural areas where lack of transportation or barriers to accessing group support can reduce health equity.
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