|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 4 | Page : 370-373
Impact of COVID-19 pandemic on treatment seeking in opioid users: A retrospective comparative study
Mini Sharma1, Dinesh Kataria2, Nitin B Raut3, Om Sai Ramesh4, Sajjadur Rehman3, BK Gracy5
1 Senior Resident, Lady Hardinge Medical College, New Delhi, India
2 Professor and Head of Department, Lady Hardinge Medical College, New Delhi, India
3 Specialist, Lady Hardinge Medical College, New Delhi, India
4 Professor, Lady Hardinge Medical College, New Delhi, India
5 Junior Resident, Department of Psychiatry and Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, India
|Date of Submission||24-Jan-2022|
|Date of Decision||13-Apr-2022|
|Date of Acceptance||06-May-2022|
|Date of Web Publication||30-Jan-2023|
Dr. Mini Sharma
6-Old Registrar Block, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Background: The planet has been hit by the novel coronavirus since December 2019, which has not only affected the day-to-day activities but has also affected the health-seeking approach of the general population. The reports from the National Institute on Drug Abuse survey hint toward a rise in opioid use in the states. Even in India, the utilization of health services, especially the outpatient department (OPD) and opioid substitution clinics have been affected due to the impact of COVID-19 and subsequent national and regional lockdowns. The Indian studies reflect upon the experience and measures to continue the treatment facilities in substance users, yet none are available to reflect upon the impact of COVID-19 on the pattern of opioid use or functionality of OPD services. Objective: The objective of this study is to study the impact of COVID-19 pandemic on treatment seeking among opioid users from OPD-based opioid treatment centers: a retrospective study. Methodology: A retrospective study was done in an OPD-based opioid treatment center of a tertiary care hospital to analyze the impact of COVID-19 on treatment-seeking opioid users by comparing the data of pre-COVID-19 (April 2019–March 2020) and during COVID-19 (April 2020–March 2021) OPD visits by opioid users. The OPD visits data were collected, including the number of visits, the total number of buprenorphine tablets dispensed, and the dose of buprenorphine consumed per month. The data collected were further analyzed for the descriptive and analytic statistics using the SPSS software version 23.0. Results: During the pre-COVID-19 (April 2019–March 2020) duration, there were a total of 1104 (average 92/month) OPD visits and 4818 (Average 401/month) buprenorphine tablets were dispensed; whereas during the COVID-19 year (April 2020–March 2021), it was 980 (average 81.66/month) visits and 5174 (431/month) tablets. The results were further compared using the paired t-test, which was found to be statistically significant for the number of tablets dispensed, whereas not statistically significant for the number of OPD visits and doses. Conclusion: Although the COVID-19 pandemic has affected the feasibility to seek treatment in opioid users, it has not significantly affected OPD visits for opioid treatment at our center. Although the policy changes such as Indian Psychiatry Society (IPS) interim guidelines for opioid substitution therapy have been beneficial to facilitate the harm reduction and treatment-seeking attitude and have not affected the treatment seeking as expected due to lockdown and transportation which have been a hurdle. Further regulations on opioid treatment OPD, Tele-consultation services and mobile mental health services may be helpful to ensure continuity of treatment and harm reduction among the opioid users.
Keywords: COVID-19, opioid users, outpatient department-based opioid clinic
|How to cite this article:|
Sharma M, Kataria D, Raut NB, Ramesh OS, Rehman S, Gracy B K. Impact of COVID-19 pandemic on treatment seeking in opioid users: A retrospective comparative study. Ann Indian Psychiatry 2022;6:370-3
|How to cite this URL:|
Sharma M, Kataria D, Raut NB, Ramesh OS, Rehman S, Gracy B K. Impact of COVID-19 pandemic on treatment seeking in opioid users: A retrospective comparative study. Ann Indian Psychiatry [serial online] 2022 [cited 2023 Mar 26];6:370-3. Available from: https://www.anip.co.in/text.asp?2022/6/4/370/368777
| Introduction|| |
The novel coronavirus marked the beginning of the pandemic in December 2019, and the first case of COVID-19 in India was detected in the last week of January 2020. The world was further hit by the national lockdown leading to the restriction of movement and hence affecting the treatment follow-up and hospital visits.
The Government of India believes that, barring a few high-risk areas (or states), widespread community transmission of COVID-19 (Stage 3 of an epidemic) has not started yet. As an aggressive precautionary measure to break the chain of viral transmission, the government has imposed an unprecedented whole-country lockdown since March 25, 2020, for 3 weeks as of now. The interstate borders have been sealed to restrict nonessential movement. All modes of public transport have been shut down; all services other than essential services have been closed down. Moreover, all outpatient-based medical services (nonemergency) have been withheld for indefinite periods.
Reviews from the public health officials also point toward the fact that the social distancing guidelines and stress surrounding the pandemic may contribute to poor mental health outcomes, including substance use. A study by Uscher-Pines et al. in 2020 also reflected on the difficulty accessing medication treatment by patients with opioid use disorder. Jacka et al., in April 2021 conducted a study to assess the impact of COVID-19 pandemic on health-care access among patients receiving medication for opioid use disorder and has reported a rise in opioid use and rapidly altered service provision in opioid treatment programs that dispense Food and Drug Administration-approved medications for opioid use disorder such as methadone and buprenorphine.
In 2020, Thornton et al. conducted a study on the impact of COVID-19-related policy changes on buprenorphine dispensing in Texas, where it was found that the rate of change of daily buprenorphine prescriptions and prescribers declined insignificantly during the COVID-19 period compared to the baseline. Similarly, a study by Downs et al., on the impact of COVID-19-related policy changes on the filling of opioid and benzodiazepine medications revealed that restricting elective procedures was associated with a significant decrease in the number of patients and prescribers filling and writing opioid prescriptions, respectively.
A cross-sectional study by Currie et al. revealed that existing patients receiving opioid analgesics and buprenorphine for opioid use disorder generally maintained access to these medications during the COVID-19 pandemic. Opioid prescriptions for opioid-naive patients decreased briefly and then rebounded, while initiation of buprenorphine remained at a low rate through August 2020, while reductions in the treatment entry may be associated with increased overdose deaths.
Galarneau et al. done a qualitative study in which several participants mentioned decreased access to housing, harm reduction, and medical care services, using drugs alone more frequently, consuming different or fewer drugs due to supply shortages, or using more drugs to replace lost activities.
There is a limited study from the Indian context on the effect of COVID-19 on opioid use and related treatment services. One quantitative study by Pal et al. in 2020 from Dehradun reported about the initial rise followed by the fall in the new and old cases of opioid users.
| Methodology|| |
The data were collected from the opioid treatment outpatient department (OPD) clinic, department of psychiatry of a tertiary health-care hospital. The data were collected for the pre-COVID-19 year from April 2019 to March 2020 and COVID-19 year from April 2020 to March 2021. It included the number of OPD visits, number of buprenorphine tablets dispensed, and its dose per month. The data were further subjected to the descriptive and analytic analyses using the SPSS software 23.0.
The data collected were analyzed using the SPSS (Statistical Package for the Social Sciences) software version 23.0 (IBM SPSS Statistics, Cengage Learning).
| Results|| |
The result was analyzed for the data from the opioid treatment OPD of a tertiary care hospital for the pre-COVID-19 (April 2019–March 2020) and COVID-19 (April 2020–March 2021). During the pre-COVID-19 duration, there were a total of 1104 which was an average of 92/month OPD visits by opioid users. Around 4818 buprenorphine tablets, i.e., average of 401 tablets/month were dispensed [Table 1].
|Table 1: (A) Pre-COVID-19 and (B) COVID-19 study period study sample data|
Click here to view
While the COVID-19 study period had an average of 81.66/month contributing to a total of 980 OPD visits. A total of 5174 tablets of buprenorphine were dispensed which were on an average of 431 tablets dispensed per month [Table 1].
The overall data were further analyzed to compare the impact of COVID-19 on the opioid users by applying a paired t-test with two samples to the study the data of pre-COVID-19 and COVID-19.
The hypothesized mean difference was 0 and 11 was the degree of freedom. Although there was a weak correlation (Pearson's coefficient-0.26) between the pre-COVID-19 and COVID-19 duration for the number of buprenorphine tablets dispensed per OPD visit, the results were statistically significant (P value one-tail = 0.02 and two-tail = 0.04). While the values were not found to be significant for the number of OPD visits (P = 0.32) and total dose of buprenorphine (P = 0.42).
| Discussion|| |
COVID-19 has impacted the accessibility to treatment due to the national and regional lockdown, cut down of resources and diversion to COVID-19-related services and decline in economic status. Hence, the data were collected from the opioid treatment OPD clinic, the department of psychiatry of a tertiary health-care hospital to assess the impact of COVID-19 on opioid users-seeking OPD-based treatment. The data were evaluated for the pre-COVID-19 year from April 2019 to March 2020 and COVID-19 year from April 2020 to March 2021, which included the number of OPD visit, the number of buprenorphine tablets dispensed, and its dose per month.
Considering the restrictions due to national lockdown and distributions of health services to COVID-19 management, a decrement in seeking opioid deaddiction treatment was expected as an outcome. Despite the direct and indirect hurdles in seeking treatment due to noble coronavirus, the results showed no drastic decrement in the OPD visits by opioid users. In the Pre-COVID-19, there were 1104 OPD visits by opioid users and the COVID-19 duration had a total of 980 OPD visits. The results are a significant reflection of ensured effective services by the regulation of new IPS Interim opioid substitution therapy (OST) guidelines 2020 and buprenorphine availability for drug deaddiction despite the pandemic adversities.
Our study findings were more positive as compared to the available Indian study by Pal et al. from Dehradun reported an average percentage of opioid use disorder per day in the three phases were as follows: Phase I − 5%, Phase II − 24%, and Phase III − 9%. However, this rise immediately vanished after the nonavailability of buprenorphine. This was not a scenario in our study as the availability of buprenorphine was ensured.
| Conclusion|| |
COVID-19 has impacted the health services, especially the deaddiction services in which opioid use has been an important focus of attention. With the regulation of the new IPS Interim OST guidelines 2020, better continuity of treatment and harm reduction have been ensured at our center. The positive outcome of our study is a promising step to ensure the continuity of treatment services amidst the pandemic with IPS guidelines regulation. The modifications in the practice of OST services keeping in mind COVID-19 have been found to be effective. Further, standard operational policies and group-specific community services would be beneficial for a better quality of services and harm reduction among the opioid user.
Strengths and limitations
The study being a pioneer pilot study helps to assess the impact of COVID-19 on opioid users-seeking OPD treatment which is reflective of harm reduction, treatment services, and further measurements for better services. Our tertiary center study had a limitation with the availability of clinical profile, distinction of new and old follow-up cases along outcome with treatment.
There is a need for a larger sample study including the clinical profile of patients and prospective design for the better understanding of COVID-19 and its impact on drug abuse. Qualitative surveys may be helpful to identify the specific barriers or facilitators to seek opioid substitution treatment. There is a need for innovations to improve accessibility to health resources and regulations to ensure adherence to opioid use disorder treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
India Fights Corona COVID-19 in India, Vaccination, Dashboard, Corona Virus Tracker | mygov.in. Available from: https://www.mygov.in/covid-19
. [Last accessed on 2021 Sep 09].
Rosoff-Verbit Z, Logue-Chamberlain E, Fishman J, Audrain-McGovern J, Hawk L, Mahoney M, et al.
The perceived impact of COVID-19 among treatment-seeking smokers: A mixed methods approach. Int J Environ Res Public Health 2021;18:505.
Uscher-Pines L, Sousa J, Raja P, Mehrotra A, Barnett M, Huskamp HA. Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine. J Subst Abuse Treat 2020;118:108124.
Jacka BP, Janssen T, Garner BR, Yermash J, Yap KR, Ball EL, et al.
Impacts of the COVID-19 pandemic on healthcare access among patients receiving medication for opioid use disorder. Drug Alcohol Depend 2021;221:108617.
Thornton JD, Varisco TJ, Bapat SS, Downs CG, Shen C. Impact of COVID-19 related policy changes on buprenorphine dispensing in texas. J Addict Med 2020;14:e372-4.
Downs CG, Varisco TJ, Bapat SS, Shen C, Thornton JD. Impact of COVID-19 related policy changes on filling of opioid and benzodiazepine medications. Res Social Adm Pharm 2021;17:2005-8.
Currie JM, Schnell MK, Schwandt H, Zhang J. Prescribing of opioid analgesics and buprenorphine for opioid use disorder during the COVID-19 pandemic. JAMA Netw Open 2021;4:e216147.
Galarneau LR, Hilburt J, O'Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, et al.
Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. PLoS One 2021;16:e0255396.
Pal A, Gondwal R, Singh Aulakh AP, Saxena V, Avinash P. COVID-19 related lockdown breaking the chain of opioid substitution services: An experience from Dehradun, India. Indian J Psychol Med 2020;42:496-8.