Changes to methadone treatment guidelines in response to COVID-19 led to improvements in overall service, study finds

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New research from RCSI University of Medicine and Health Sciences indicates that several measures implemented during COVID-19 to maintain access to opioid agonist treatment (OAT) led to improvements in the service and should be continued post-pandemic.

The study, led by researchers in the RCSI School of Pharmacy and Biomolecular Sciences, has been published in the International Journal of Drug Policy.

OAT is type of a treatment in which 'opioid agonists' – most commonly methadone – are prescribed for people who are dependent on opioids such as heroin. OAT helps to suppress heroin use, improves mental and physical well-being, and reduces risk of death including drug overdose deaths. A 2019 study showed there were over 10,000 people receiving OAT in Ireland.

Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. Certain measures, such as rapid assessments and telehealth, enabled services to overcome many of the usual barriers to providing treatment. As a result, waiting lists for OAT were drastically reduced, with over 11,000 people accessing treatment in 2021.

This study, funded by the Health Research Board, consulted a panel of experts and stakeholders including psychiatrists, GPs and pharmacists, as well as people who were accessing OAT for opioid dependency, to identify which of the OAT contingency measures implemented as a result of COVID-19 should be continued.

The panel recommended 16 changes to be continued beyond COVID-19 in Ireland, rather than reverting to pre-pandemic practices. The agreed statements related to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Consensus was not achieved for OAT drug dosing and frequency of urine testing.

Dr Gráinne Cousins, Senior Lecturer in the RCSI School of Pharmacy and Biomolecular Sciences and the study's principal investigator, commented on the findings: "The emergence of the COVID-19 pandemic transformed how OAT was delivered, in Ireland and internationally. While many authors have suggested that recent innovations should be continued beyond the pandemic, this is the first study to seek consensus, among a wide range of stakeholders, on whether recommendations introduced in emergency clinical guidelines should be retained beyond the pandemic.

"These consensus recommendations are intended to inform future policy decisions and discussions regarding the delivery of OAT, identifying which changes should be considered for integration into care models beyond COVID-19. For example, all people on OAT should be prescribed and encouraged to take a supply of Naloxone (a medicine that rapidly reverses an opioid or heroin overdose), particularly during high-risk periods. They should also be trained on how to use Naloxone."

About the Health Research Board

The Health Research Board (HRB) is Ireland's lead funding agency supporting innovative health research and delivering data and evidence that improves people's health and patient care. We are committed to putting people first, and ensuring data and evidence are used in policy and practice to overcome health challenges, advance health systems, and benefit society and economy.