The National Drug Abuse Clinical Trials Network: New England Consortium Node

PROJECT Summary: The coronavirus disease 2019 (COVID-19) pandemic poses unique threats to individuals with opioid usedisorder (OUD).1,2 They are likely to be particularly vulnerable to COVID-19 and the public health measures(i.e., social distancing) to control the disease.3,4 Specifically, individuals with OUD in remission may be atsubstantial risk for return to opioid use given disruptions in addiction treatment, such as medications for OUD(MOUD). In addition, stress due to social distancing, finances, loss of employment or housing may be a triggerfor return to use. COVID-19 may result in changes in illicit opioid supply and diverted buprenorphine andmethadone as programs and clinicians follow federal recommendations and provide patients with more takehome doses of methadone (increasing risk for overdose and diversion) and longer prescriptions ofbuprenorphine. Separately, there is concern that OUD-related stigma, lack of usual source of care, andpotential consequences of a positive test (e.g., housing situation), individuals with OUD may be less likely toseek a COVID-19 test even when clinically recommended. Importantly, all of these factors may vary widelybased on geography. To provide urgent insights on the potential impact of COVID-19 on individuals with OUDin four US cities, and informed by prior research,5,6 we will leverage the >700 patients enrolled in Project ED-Health (CTN-0069) and research infrastructure7 to reach individuals with OUD. Specifically, we will attempt tocontact all 738 individuals who were enrolled in Project ED-Health, at one of our four participating emergencydepartments (ED) located in New York, NY; Baltimore, MD; Seattle, WA; and Cincinnati, OH, to participate in afollow-up one time telephone-based survey. We will collect self-reported data on the impact of the COVID-19epidemic on opioid use and treatment and COVID-19 symptoms and testing. We will triangulate these datawith an electronic survey of medical directors and site-Principal Investigators at each site to capture data onthe impact of COVID-19 on ED presentations and experiences of patients with OUD. This work will beconducted by a team of investigators that has robust experiences in developing and implementing surveys,8-12linking self-reported and electronic health record data,13-15 and conducting longitudinal research with individualswith OUD.16-20 Thus, among a geographically diverse (Northeast, Mid-Atlantic, Midwest, West Coast) sample ofindividuals with OUD, we seek to characterize the impact of the COVID-19 pandemic on (Aim 1) OUDtreatment (engagement and access to MOUD), drug use, drug supply, and overdose risk, (Aim 2) COVID-19related symptoms and testing, and (Aim 3) ED leadership reports of the presentation of patients with OUD tothe ED, ED-based buprenorphine prescribing practices, and community treatment options. These timesensitive data are urgently needed to begin to understand the impact of COVID-19 among individuals withOUD to directly inform clinical interventions and policies.