Perceived impact of COVID-19 on prevention, treatment, harm reduction, and recovery services for opioid use disorder: National survey of local health departments

Abstract

Background: US local health departments (LHDs) have faced the COVID-19 pandemic and the opioid epidemic simultaneously. This article investigates the perceived impact of COVID-19 on the continuation of locally available services for addressing opioid use disorder (OUD). Methods: A national survey of US LHDs was conducted from November to December 2020. The survey asked key personnel in LHDs about the availability of OUD services in their jurisdiction, and how COVID-19 impacted such availability (i.e., whether terminated or continued at a reduced, the same, or an increased level after the arrival of COVID-19). Proportions for each impact category were estimated for prevention, treatment, harm reduction, and recovery services. Logistic regression tested for rural-urban and regional differences in perceived service impact. Results: An 11.4% (214 out of 1873) response rate was attained. Of the returned surveys, 187 were used in the analysis. Reported terminations were generally low, especially for treatment services. School-based prevention initiatives had the highest termination rate (17.2%, 95% CI = 11.4–25.1%). Prevention services had the highest proportions for continuing at a reduced level, except for recovery mutual help programs (53.9%, 95% CI = 45.2–62.4%). LHDs reported continuing services at an increased level at a higher frequency than terminating. Notably, 72.2% (95% CI = 62.7–80.0%) continued telehealth/telemedicine options for OUD at an increased level, and 23.8% (95% CI = 17.8–31.1%) and 10.0% (95% CI = 5.7–16.7%) reported doing the same for naloxone distribution and medications for opioid use disorder (MOUD), respectively. More harm reduction services were continued at the same versus at a reduced level. Service continuation differed little between rural-urban LHDs or by region. Conclusions: The impacts of COVID-19 on OUD service availability in LHD jurisdictions may depend on the specific area of opioid response while the long-term consequences of these changes remain unknown.

Keywords:

• Community health services
• COVID-19
• local health departments
• opioid epidemic

Acknowledgments

The authors would like to thank (alphabetically listed) Diana Hardinge, Sojeong Kim, MPP, Megan Lamiotte, MPA, and Emma Ogg, BA for their assistance with data collection. In addition, the authors would like to thank (alphabetically listed) J. Scott Bainbridge, MD, JK Costello, MD, MPH, Jeff Hanley, BA, Francis Higgins, MSc, Natalie Kraus, MHA, Maura Proser, DrPH, MPH, Katie Schweber, MPH, Heidi Williams, MPA, and Steven Wright, MD for their input on the survey questionnaire. The authors are grateful to the University of Colorado Denver Office of Research Services and the School of Public Affairs for supporting this research.

Disclosure statement

No potential conflict of interest was reported by the author(s). The views expressed in this article are those of the authors and do not necessarily reflect the views of the University of Colorado Denver or any of its affiliates.

Author contributions

WS, TS, and HM conceived of the study. WS, TS, SK, and JH managed the data collection effort. WS, TS, and HM led the writing of the manuscript. WS, SK, and JH performed the data analysis. All authors, WS, TS, SK, HM, and JH, provided critical feedback and contributed to the writing of the manuscript.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research is based upon work supported by the Office of Research Services and the School of Public Affairs at the University of Colorado Denver and West Chester University of Pennsylvania, which had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.