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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.