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Table 1 Changes to pharmaceutical alternative services as a result of COVID-19

From: The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

Changes to services

iOAT

N = 19

TiOAT

N = 3

SS

N = 60

Total

N = 82

Staffing totals

12

1

77

90

 Added positions

8

1

29

 

 Reduced/redeployed positions

3

0

24

 

 Staff worked from home

1

0

23

 

 Staff hours staggered

0

0

1

 

Ancillary services totals

32

4

91

133

 Referrals delayed/canceled

5

3

10

 

 Community meetings eliminated

2

0

1

 

 Care moved outdoors

1

0

2

 

 Virtual ancillary care

12

1

45

 

 Reduced services/activities

5

0

21

 

 Bulletin board, books, fabric, art supplies removed

3

0

14

 

 Food services reduced/take-out only

4

0

4

 

Program operations totals

102

18

222

342

 No new client intakes

12

1

7

 

 Screening upon entry or pre-screened by phone

17

3

35

 

 Staff required to wear PPE

15

3

30

 

 Clients encouraged/required to wear PPE

16

3

31

 

 Increased access to/expectation of hand sanitizer use/handwashing upon entry

15

3

23

 

 Reduced laboratory hours

6

1

7

 

 Video/phone appointments

12

3

44

 

 Reduction in frequency patients seen by physician

6

1

32

 

 One clinician covers all in-person appointments

0

0

2

 

 Mobile team created to support clients at home

1

0

9

 

 Limited/restricted outreach to clients at home

2

0

2

 

Use of physical space totals

121

21

226

368

 Reduced/repositioned furniture

14

3

23

 

 Reduced # of clients in clinic/injection room

18

3

32

 

 Reduced # clients in chill out/waiting/shared activities room

14

3

23

 

 Bathrooms closed to patients

2

2

2

 

 Client entry denied/discouraged for non-treatment purposes

10

3

16

 

 Creation/use of isolation room

8

0

12

 

 Physical distancing enforced

13

3

20

 

 Plexiglass installed

6

0

16

 

Additional/enhanced cleaning

18

3

52

 

 Decreased amount of space available for treatment

5

0

15

 

 Limited tours/fellowship placements

13

1

15

 

Client protocols totals

129

13

205

347

 Reduction in urine drug test frequency

12

1

26

 

 Swabbing clients suspected of being COVID+

11

1

16

 

 Stop/reduce post-dose adverse reaction monitoring period

15

0

13

 

 Take-home/carries to stable patients

13

1

27

 

 Reduced # of injections (with patient consent)

7

NA

NA

 

 Less frequent dose pickup

2

1

12

 

 Extending/renewing prescriptions at the pharmacy

0

0

14

 

 TiOAT/iOAT patients offered safe supply

6

1

NA

 

 Daily delivery

3

1

25

 

 Shorter titration schedule/expedited dose increases

8

0

33

 

 Transition to oral OAT encouraged

10

1

1

 

 Pre-filled syringes

2

NA

NA

 

 Provide/replace oral hydromorphone in addition to iOAT

14

NA

NA

 

 SROM administered as full capsule (no sprinkles)

12

3

16

 

 Changed overdose response/Code Blue procedures

14

3

22

 
  1. iOAT = injectable opioid agonist treatment; TiOAT = tablet-based iOAT; SS = safer supply; OAT = opioid agonist treatment; SROM = slow-release oral morphine; PPE = personal protective equipment; NA = not applicable