Studying How State and Local Health Services Delivery Policies can Mitigate the Effects of Disasters on Drug Addiction Treatment and Overdose: A Mixed-Methods Study of COVID-19.

NIH Pandemic-Era Grants

Pandemic Era Grants

2024

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Principal Investigator: Matthew  Eisenberg
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $673,232
Funding agency: National Institute on Drug Abuse

ABSTRACT
Public health disasters and the drug addiction and overdose epidemic are among the foremost public health
issues facing the United States. Disaster-related disruptions to drug addiction treatment and overdose
prevention services can be life-threatening to people with drug addiction. Public policies form the backbone of
disaster response by delineating what health systems can and cannot do in the midst and aftermath of
disasters. There are several types of state health service delivery policies with the potential to enhance access
to drug addiction treatment and prevent overdose during disasters e.g., state telehealth policies allowing
addiction treatment services to be delivered by phone, as opposed to video conference (a policy that may
benefit people with drug addiction who lack computer and/or high-speed internet access); state harm reduction
policies loosening restrictions on naloxone distribution during disasters; and state policies waiving in-person
methadone dosing requirements and allowing individuals with opioid use disorder to take home a 14-28 days'
supply. The implementation and effects of these policies on addiction treatment and overdose in the disaster
context have not been studied; we will fill this gap by studying these policies in the context of the COVID-19
pandemic. We propose a mixed-methods study using a concurrent-embedded design. In Aims 1-2, we will
conduct a 50-state study using a difference-in-differences approach to examine the effects of the state health
services delivery policies of interest on rates of drug addiction treatment and fatal and non-fatal drug overdose.
Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the
general medical sector (IQVIA LRx/Dx and United Healthcare) and specialty addiction treatment sector
(TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative case studies
of eight US states hard-hit by COVID-19, with embedded case studies of local public health and healthcare
systems in urban and rural counties within those states. A strength of the proposed study is its use of a
concurrent embedded mixed-methods strategy, where qualitative case studies (Aim 3) will answer questions
not addressed by the primary quantitative method (Aims 1-2). Our study will yield actionable evidence to
inform policy development and implementation to enhance continuity to addiction treatment and prevent drug
overdose during future disasters.

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