Revising our attitudes towards agonist medications and their diversion in a time of pandemic

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Highlights

  • COVID-19 resulted in the significant relaxation of critical MOUD prescribing rules.

  • Retention in treatment was prioritized over preventing MOUD misuse and diversion.

  • Diverted and prescribed agonist MOUDs may both serve as a means of overdose prophylaxis during the pandemic.

  • These prescribing changes offer an opportunity to reconsider our attitudes towards agonist medications and their diversion.

Abstract

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.

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This work was supported by the National Institute on Drug Abuse (grant T32DA013911), and the National Institute of General Medical Science (grant P20GM125507). The institutes had no role in the preparation of this article, and the opinions expressed are the authors' alone.

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