Improving Access to Medications for Opioid Use Disorder: Lessons from the COVID-19 Pandemic
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Decreasing regulations would allow for the development and implementation of innovative, community-based programs that would support patient safety, autonomy and well-being.
Opioid use disorder (OUD) affects millions of people in the United States, and more than 200 people died each day of an opioid-involved overdose in 2021. Medication for opioid use disorder (MOUD) is an evidence-based approach that can cut the risk of overdose in half and improve a range of health and social outcomes. Nonetheless, a minority of those living with OUD are engaged in MOUD-based recovery. A diverse swathe of experts—including scholars, on-the-ground harm reductionists and treatment providers—agree that one of the most important barriers to accessing MOUD is overly restrictive policy. Indeed, the two most effective and widely used MOUDs (methadone and buprenorphine) are controlled substances and, as such, are subject to tight, multiagency restrictions that affect who can prescribe them, how they may be dispensed, and the conditions around patient possession and consumption.
Beginning in March 2020, the unique context of the COVID-19 pandemic led government agencies to relax some of these restrictions with the aim of ensuring that MOUD would remain accessible. This study reviews the pre- and post-COVID MOUD policy environments and synthesizes the literature on health and social outcomes to identify key ways in which these changes affected MOUD access and use, as well as patient treatment experiences.
Our research indicates that the MOUD policy changes, while not uniformly applied, had net positive effects. Although the inconsistent adoption of the policy changes and the complexity of COVID-19-era circumstances made it difficult to assess population-level impacts, the key health and safety outcomes among patients who received buprenorphine via telehealth or increased take-home doses of methadone were that: (1) MOUD-involved overdoses did not significantly increase and (2) treatment outcomes and patient acceptance remained on par with or superior to pre-pandemic baselines. As such, while individual experiences with and preferences for specific pandemic-era protocols varied, patients and providers were generally supportive of continuing with the relaxed restrictions.
Despite these successes, our research indicates that the rule changes were not sufficient to close gaps in MOUD treatment. In particular, several persistent structural and sociocultural barriers require attention to maximize the benefits of relaxed regulation. Stigma; economic and geographic disparities in access to digital technology; and complicated payment and reimbursement systems all contributed to inequities in MOUD access and outcomes, even in a more permissive policy environment. Based on these findings, we recommend extending and expanding upon the COVID-era changes, and we call on states to recognize and follow the evidence-based loosening of regulations with the understanding that continued work will be necessary to address additional barriers to equitable access.