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

Franciska Brezan; Maximilian Meyer; Marc Vogel; Jakob Heimer; Luis Falcato; Jonas Montagna; Philip Bruggmann

doi:10.1111/add.16503

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

Addiction. 2024 Apr 21. doi: 10.1111/add.16503. Online ahead of print.

Authors

Franciska Brezan¹, Maximilian Meyer^{2

3}, Marc Vogel², Jakob Heimer⁴, Luis Falcato¹, Jonas Montagna¹, Philip Bruggmann^{1

5}

Affiliations

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.

PMID: 38644677
DOI: 10.1111/add.16503

Abstract

Background and aims: Legal 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 participants: This 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.

Measurements: Through 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).

Findings: DAM 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.

Conclusion: Allowing 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.

Keywords: COVID‐19 pandemic; Cohort study; DAM; HAT; OAT; retrospective; take‐home.