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Background Organizational responses to crises can profoundly impact the operations and functioning of programs. Specifically, the COVID-19 pandemic led to an 18% increase in drug overdoses and necessitating significant protocol adjustments. We examined opioid treatment programs (OTPs) responses to the pandemic, and associations with clients' perceptions of COVID-19 concerns and perceptions of effect and overall impact. Methods Data from 2023 encompassing 92 OTPs and 435 client surveys were analyzed using multilevel regression models. Dependent variables measured clients COVID-19 exposure concerns, and perception of the pandemic’s broader impact. Independent variables included types of response, staff composition, funding, and accreditation. Results Clients in programs with higher proportions of African Americans, 1.02 (95% Confidence Interval CI = 1.00—1.03) or Latino staff, 1.03 (CI = 1.01—1.04) expressed significantly greater concern about COVID-19 exposure. Conversely, clients in publicly funded programs reported significantly lower concern about exposure, 0.37 (CI = 0.15—0.90). On the other hand, programs with more administrative responsiveness, 1.44 (CI = 0.07—2.80), or accreditation by the Commission on Accreditation of Rehabilitation Facilities, 1.90 (CI = 0.13—3.67), were associated with significantly higher perceived overall impact of the pandemic, respectively. Conclusion This study highlights the intricate connection between program characteristics and organizational responses during public health crises. Our findings underscore the importance of culturally sensitive approaches and effective communication to address client COVID-19 concerns and perceptions, particularly within disproportionately affected minority communities. These insights emphasize the necessity for OTPs to adapt to meet the evolving needs of clients, ensuring that they receive the support and care required during uncertainties. Highlights • Clients of OTPs with a higher proportion of minority staff reported greater COVID-19 concerns • Publicly funded programs were associated with lower client concerns about exposure • Greater administrative responsiveness was associated with higher perceived effect of COVID-19 • Greater administrative responsiveness was marginally associated with a decline in exposure concerns • Accreditation by CARF was associated with higher perceived effect of COVID-19

Introduction Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP. Aim Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage. Setting Seven hundred-bed university hospital in Aurora, CO. Program Description A physician dually affiliated with a hospital’s addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins. Program Evaluation Metrics IN-MEET enrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments. Results Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients ( n  = 1687), a higher percentage of IN-MEET patients were older (39.7 years, standard deviation [SD] 11.2 years vs. 36.1 years, SD 10.6 years) and were unhoused ( n  = 43, 58.9% vs. n  = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance ( n  = 53, 72.6% vs. n  = 677, 40.1%), reported methamphetamine as their secondary substance ( n  = 27, 37.0% vs. n  = 380, 22.5%), and reported they injected their primary substance ( n  = 46, 63.0% vs. n  = 478, 28.3%). Conclusion IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality.

This chapter contains sections titled: External Barriers Internal Barriers to Prescribing Strategies to Address Prescribing Barriers Eliminating External Barriers to Prescribing Eliminating Internal Barriers to Prescribing Implications Conclusion

Disruptions in opioid treatment programs (OTPs) are common after major disasters. Highly regulated OTPs confront challenges when responding to extended closures following disaster. Following Hurricane Sandy in 2012, an OTP located at the Manhattan Veteran Affairs Medical Center (VAMC) closed for 5 months. Semistructured interviews were conducted with clinicians and administrators who participated in the evacuation of the Manhattan VAMC, including the co-located OTP program. The Manhattan OTP preemptively dispensed emergency take-home methadone doses. Following closure, emergency guest-dosing arrangements were made for approximately 100 Veterans with Veterans Affairs (VA) and non-VA OTPs throughout New York City. Fortuitously, a retired VA OTP at another facility was reopened and accredited expeditiously. OTPs must improve contingencies for emergency response. However, disruptions in methadone delivery and threats to patient safety are likely to continue until agencies with oversight authority of OTPs describe specifications for emergency alternate care sites during long-term disaster recovery.