Evaluation of Low Threshold Buprenorphine Treatment in the Context of COVID-19

PROJECT SUMMARY/ABSTRACT Buprenorphine is an evidence-based pharmacological approach to treating opioid use disorder (OUD). Despite its efficacy, buprenorphine is significantly underutilized, in part, because of historically rigid requirements for treatment entry and continuation. To address this concern, there have been recent calls to establish "low threshold" care to remove barriers to treatment and improve overall access. The COVID-19 pandemic has placed an unprecedented strain on the U.S. population and healthcare system. Social distancing measures are now in place to mitigate the risk of viral transmission. While these public health policies may protect against contracting COVID-19, they also have the potential to disrupt treatment for substance use disorders, particularly OUD, which relies heavily on face-to-face healthcare delivery. In response to such concerns, new guidelines have been released to encourage greater flexibility in the prescribing of buprenorphine. These changes have the potential to increase access to and success with buprenorphine treatment for individuals with OUD, however, it remains unknown how systematic changes related to COVID-19 may affect the practice of buprenorphine prescribing, treatment utilization, or impact on patient outcomes. The objective of the present study is to examine, through a mixed-method approach, the preliminary association of the COVID-19 pandemic with the provision of buprenorphine treatment and patient-level outcomes across three outpatient buprenorphine clinics affiliated with the largest hospital system in the state of Rhode Island. Through this Notice of Special Interest (NOSI), the proposed study will capture and characterize time-sensitive changes that are occurring to buprenorphine treatment as a result of COVID-19. Information obtained through this study will identify key factors that may influence implementation of a low threshold approach following the COVID-19 pandemic. Additionally, this proposal seeks to empirically evaluate a) changes to buprenorphine prescribing practices and treatment, and b) how changes to the delivery of care impact patient-level outcomes. Results of this study may be leveraged to inform best-practice guidelines for buprenorphine prescribing to ensure safety and efficacy of OUD treatment. The aims outlined within this application align with the overall objectives of COBRE on Opioids and Overdose to address the opioid crisis by mentoring junior investigators so that they may transition into independent clinical researchers focused on the development and evaluation of evidence-based treatment for OUD.