Southwest Health Equity Research Collaborative (1)

During the COVID-19 Pandemic, the United States Drug Enforcement Administration (DEA) temporarilyrelaxed restrictions to best serve people in treatment for substance use disorders (SUD) during socialdistancing mandates. Changes include allowing longer take home doses of methadone and buprenorphinerather than coming to the clinic every day (for methadone) or weekly (for buprenorphine), and relaxedrestrictions on telehealth prescribing and treatment. These changes directly and indirectly impact theapproximately 14,500 substance use treatment programs in the United States, but the actual implementation ofthe 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 thewake of COVID-19. To accomplish these goals, we propose to use Rapid Assessment, Response andEvaluation (RARE) methods to complete the following specific aims: AIM 1: Identify barriers and facilitatorsto 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: Assessimplementation 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-methodapproach 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 responsiveassessment and evaluation within a much shorter timeframe than conventional research. We propose to useRARE methods to collect information about online care delivery program barriers and facilitators, and toprovide local communities with information about local equity, acceptability, and feasibility of potentialtelehealth and mHealth interventions. The knowledge to be gained from the proposed project will contribute tounderstanding how DEA guideline changes during COVID-19 were implemented and experienced bystakeholders, providers, and patients in treatment for opioid dependence. The proposed study is expected toprovide in-depth information about providers' and patients' experiences of the changes and inform the debateat the national level about whether policy guideline changes should become permanent after COVID-19 riskhas lessened. There is a pressing need to document experiences of the new guidelines as policymakersdecide whether to make the guidelines permanent. In-depth investigation stands to fills key gaps inunderstanding about whether and how increased access to medication-assisted treatment and more access totreatment via telehealth and mHealth platforms can improve equity for people in rural and underserved areaswho have limited access to care for substance use disorders.