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Opioid Treatment Programs and Risks for COVID-19 Infections, Emergency Visits, and Hospitalizations

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Abstract

Background

The COVID-19 pandemic spurred relaxation of opioid treatment program (OTP) in-person daily dosing requirements. This policy change was met with widespread enthusiasm by patients and providers and did not increase illicit opioid use, overdose, or medication diversion. However, it is not known whether the policy change was effective at mitigating the COVID-19 public health emergency among people with opioid use disorder (OUD) receiving treatment at OTPs.

Objective

To evaluate the impact of treatment at OTPs on rates of COVID-19 infections and complications.

Design

Prospective cohort from 4/1/2020 to 3/31/2021.

Participants

Oregon Medicaid beneficiaries with an OUD diagnosis.

Main Measures

The exposure was time-varying treatment for OUD, including (1) medication treatment at an OTP, (2) office-based opioid medication treatment (OBOT), (3) other treatment without medications for OUD, or (4) no treatment. Outcomes were COVID-19 diagnoses, COVID-related emergency department visits, and COVID-related hospitalizations.

Results

Participants (N = 24,654) averaged 39 years old, most were female (53%), White (84%), and non-Hispanic (88%). Adjusted for characteristics and comorbidities, OTP patients demonstrated significantly reduced risk of COVID-19 diagnoses compared to all other groups: a 37% reduction compared to OBOT, a 52% reduction compared to non-MOUD treatment, and a 37% reduction compared to no OUD treatment. OTP treatment was also associated with a 40% risk reduction of COVID-related ED visits compared to OBOT, a 56% reduction compared to non-MOUD treatment, and a 46% risk reduction compared to no treatment. For inpatient stays, there was not a significant difference between OTP and OBOT treatment or no treatment, but OTP treatment was associated with a 64% risk reduction compared to non-MOUD treatment.

Conclusions

Lower risks of COVID-19 diagnoses and complications were observed among people with OUD receiving treatment at OTPs compared to other forms of treatment or no treatment.

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Data Availability

Unfortunately, access to the All Payer All Claims database is governed by the Oregon Health Authority. Requests for data can be directed to https://www.oregon.gov/oha/hpa/analytics/pages/all-payer-all-claims.aspx.

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Funding

This work was funded by the National Institute on Drug Abuse (3 UH3 DA044831-03S1; K01 DA55130) and the Agency for Healthcare Research and Quality (K12 HS026370).

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Authors and Affiliations

  1. Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA

    Ryan R. Cook PhD, Kim Hoffman PhD, Ximena A. Levander MD, P. Todd Korthuis MD & Dennis McCarty PhD

  2. Comagine Health, Portland, OR, USA

    Kendra L. Blalock MS, Sanae El Ibrahimi PhD & Gillian Leichtling BA

  3. School of Public Health, University of Nevada, Las Vegas, USA

    Sanae El Ibrahimi PhD

  4. Washington County Health and Human Services, Public Health Division, Hillsboro, OR, USA

    Kacey Little MPH

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  1. Ryan R. Cook PhD
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Correspondence to Ryan R. Cook PhD.

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Prior Presentations

Preliminary results were presented at the 85th annual meeting of the College on Problems of Drug Dependence, June 17–21, 2023, Denver, CO.

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Cook, R.R., Blalock, K.L., El Ibrahimi, S. et al. Opioid Treatment Programs and Risks for COVID-19 Infections, Emergency Visits, and Hospitalizations. J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-09444-3

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