Prolonged diacetylmorphine take‐home during the COVID‐19 pandemic—Results of a retrospective cohort study

Author:

Brezan Franciska1ORCID,Meyer Maximilian23ORCID,Vogel Marc2,Heimer Jakob4,Falcato Luis1,Montagna Jonas1,Bruggmann Philip15

Affiliation:

1. Arud Centre for Addiction Medicine Zurich Switzerland

2. Psychiatric University Clinics Basel University of Basel Basel Switzerland

3. Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver Canada

4. Department of Mathematics, Seminar for Statistics ETH Zurich Zurich Switzerland

5. Institute of Primary Care, University Hospital Zurich University of Zurich Zurich Switzerland

Abstract

AbstractBackground and aimsLegal regulations for dispensing in Swiss heroin‐assisted treatment were relaxed during the COVID‐19 pandemic, allowing prolonged take‐home of up to 7 days instead of two to reduce patient contact and the risk of infection. Our study aimed to measure the consequences of this new practice.Design, setting and participantsThis was a retrospective cohort study set in Switzerland’s largest outpatient centre for opioid agonist therapy. One hundred and thirty‐four (72.4%) of the 185 patients receiving oral diacetylmorphine (DAM) participated in the study.MeasurementsThrough the utilization of electronic medication prescription and dispensing software, as well as the electronic medical record, the following data were extracted to explore the potential consequences: dose of DAM, the number of antibiotic therapies, emergency hospitalizations and incarcerations. Age, gender, prescriptions for psychotrophic drugs and additional prescription for injectable DAM were tested to assess an increased risk of losing prolonged take‐home privileges. Data in the year since prolonged take‐home (period 2) were compared with data from the equivalent prior year (period 1).FindingsDAM take‐home was not associated with a change in DAM dose (P = 0.548), the number of emergency hospitalizations (P = 0.186) or the number of incarcerations (P = 0.215); 79.1% of all patients were able to maintain their extended take‐home privileges. However, patients who had injectable DAM experienced significant reductions in their prolonged take‐home privileges.ConclusionAllowing patients to take home oral diacetylmorphine for up to 7 days as treatment for opioid use disorder does not appear to pose any demonstrable health risk. It is generally manageable for the large majority of patients. However, careful consideration of prolonged take‐home for patients with additional injectable diacetylmorphine is recommended, as these patients are more likely to lose take‐home privileges.

Publisher

Wiley

Reference47 articles.

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5. SchaubM BolligerH HiltebrandD.Heroingestützte Behandlung—Veränderung der Klientel in der Schweiz und Review der Kostenanalysen Schlussbericht [Heroin‐assisted treatment—change in the clientele in Switzerland and review of the cost analyses final report]. Zürich Germany: Swiss Institute for Addiction and Health Research (ISGF);2013.

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