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April 7, 2021

AUTHOR
Patricia Strach
Elizabeth Pérez-Chiqués
Katie Zuber

 

Executive Summary

In early 2020, as COVID-19 spread to the United States, federal and state policymakers responded with extraordinary changes to policy, regulations, and guidelines. New York Governor Andrew Cuomo put the state on “pause,” closing nonessential businesses to the public and sending nonessential employees home in March and laying out a series of guidelines for social distancing and personal protective equipment (PPE) shortly thereafter. At the same time, federal and state agencies overseeing substance-use disorder services relaxed stringent requirements for what could be provided (increased methadone take-home dosages), how services could be provided (allowing a wide range of telepractice services via video and audio), and shelving burdensome requirements (including in-person physical exams and frequent toxicology screenings).

In this report, we examine what happened to New York State’s substance-use disorder services during the COVID-19 pandemic. How did COVID-19 affect the range of substance-use disorder services? What policy changes allowed for the safe and efficient provision of substance-use disorder services and which ones did not? And, what practices should be pursued moving forward?

To answer these questions, we partnered with the Alcoholism and Substance Abuse Providers of New York State (ASAP) to conduct a series of nine focus groups with providers and clients (81 total participants).

We found:

1. Substance-use disorder service providers faced a similar set of challenges with staffing, technology, fewer clients, and reduced revenues. Yet, what they did to adapt to the pandemic, the relative weight of the challenges, and the effect on services varied by type of service provider (residential, outpatient, opioid-treatment program (OTP), prevention, recovery, harm reduction).
2. Across the board, providers appreciated the flexibility of relaxed regulatory guidelines, allowing them to offer patient-centered care through telehealth, medication-assisted treatment (MAT), and fewer toxicology screenings. Providers noted frustration with aspects of policy and policy implementation, including lack of guidance, essential-worker status, and fiscal constraints.
3. COVID-19 offers policymakers and providers the opportunity to make changes to better provide substance-use disorder services in the future, including: flexibility of relaxed guidelines (telehealth, MAT, screenings, billing); better planning and preparation; more integrated services; fixing long-term staffing and finance issues; and including providers in the decision-making process.

COVID-19 captured public attention. But the onset of the pandemic did not lessen the burden of the overdose epidemic. Rather, access to substance-use disorder services has been more difficult and overdose deaths have increased. But the pandemic does offer lessons about the ability to provide substance-use disorder services in emergencies, the policy changes we can learn from, and productive avenues to pursue moving forward.

Read the full report.