{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:07:14Z","timestamp":1789085234448,"version":"build-2803163510"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020097","name":"Foundation for Opioid Response Efforts","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100020097","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Vitalyst Health Foundation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and\/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using <jats:italic>a priori<\/jats:italic> codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0274094","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T17:28:13Z","timestamp":1666718893000},"page":"e0274094","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":28,"title":["Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1762-7179","authenticated-orcid":true,"given":"Beth E.","family":"Meyerson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith G.","family":"Bentele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Russell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin R.","family":"Brady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Missy","family":"Downer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto C.","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Garnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlene","family":"Mahoney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Samorano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Arredondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honey J.","family":"Andres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Coles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Granillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"pone.0274094.ref001","article-title":"Coronavirus disease 2019 and Opioid use: A pandemic within an epidemic","author":"S Slat","year":"2020","journal-title":"JAMA Health Forum"},{"key":"pone.0274094.ref002","unstructured":"Arizona Health Care Cost Containment System. Arizona Statewide Prevention Needs Assessment. [online]: https:\/\/www.azahcccs.gov\/Resources\/Downloads\/Grants\/ArizonaSubstanceAbusePreventionNeedsAssessment.pdf Accessed July 28, 2020."},{"issue":"108617","key":"pone.0274094.ref003","article-title":"Impacts of COVID-19 pandemic on healthcare access among patients receiving medication for opioid use disorder","volume":"221","author":"BP Jacka","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"pone.0274094.ref004","article-title":"COVID-19 impact on US national overdose crisis","author":"A Alter","year":"2020","journal-title":"Overdose Detection Mapping Application Program (ODMAP)"},{"issue":"356","key":"pone.0274094.ref005","first-page":"1","article-title":"Drug overdose deaths in the United States, 1999\u20132018","author":"H Hedegaard","year":"2020","journal-title":"NCHS Data Brief"},{"issue":"6","key":"pone.0274094.ref006","doi-asserted-by":"crossref","first-page":"e196373","DOI":"10.1001\/jamanetworkopen.2019.6373","article-title":"Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder","volume":"2","author":"RL Haffajee","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"Suppl 1","key":"pone.0274094.ref007","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1016\/j.drugalcdep.2016.08.642","article-title":"Buprenorphine physician supply: Relationship with state-level prescription opioid mortality","volume":"173 Suppl 1","author":"HK Knudsen","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"9","key":"pone.0274094.ref008","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1001\/jamapsychiatry.2019.0876","article-title":"Buprenorphine treatment divided by race\/ethnicity and payment","volume":"76","author":"PA Lagisetty","year":"2019","journal-title":"JAMA Psych"},{"issue":"4","key":"pone.0274094.ref009","doi-asserted-by":"crossref","first-page":"e203711","DOI":"10.1001\/jamanetworkopen.2020.3711","article-title":"Association of racial\/ethnic segregation with treatment capacity for opioid use disorder in counties in the United States","volume":"3","author":"WC Goedel","year":"2020","journal-title":"JAMA Network Open"},{"issue":"3","key":"pone.0274094.ref010","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s11414-013-9341-3","article-title":"Variation in use of buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City","volume":"40","author":"HB Hansen","year":"2013","journal-title":"J Behav Health Serv Res"},{"key":"pone.0274094.ref011","volume-title":"Federal Guidelines for Opioid Treatment Programs","author":"United States Substance Abuse and Mental Health Services Administration","year":"2015"},{"key":"pone.0274094.ref012","unstructured":"Public Law No: 110\u2013425 (10\/15\/2008) otherwise known as the Ryan Haight Online Pharmacy Consumer Protection Act of 2008."},{"key":"pone.0274094.ref013","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1007\/s10461-020-02887-1","article-title":"Rapid implementation of service delivery changes to mitigate COVID-19 and maintain access to methadone among persons with and at high risk for HIV in an opioid treatment program","volume":"24","author":"KM Peavy","year":"2020","journal-title":"AIDS Behavior"},{"issue":"6","key":"pone.0274094.ref014","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1377\/hlthaff.2020.02261","article-title":"Addressing racial and ethnic disparities in the use of medications for opioid use disorder","volume":"40","author":"B. Andraka-Christou","year":"2021","journal-title":"Health Affairs"},{"key":"pone.0274094.ref015","author":"United States Substance Abuse and Mental Health Services Administration (SAMHSA)","year":"2020","journal-title":"FAQs: Provision of methadone and buprenorphine for the treatment of Opioid Use Disorder in the COVID-19 emergency"},{"key":"pone.0274094.ref016","unstructured":"Drug Enforcement Agency (DEA), Diversion Control Division. Use of telemedicine while providing medication assisted treatment (MAT). https:\/\/tinyurl.com\/ycvuj99z"},{"key":"pone.0274094.ref017","author":"Centers for Medicare and Medicaid Services (CMS)","year":"2020","journal-title":"COVID-19: CMS allowing audio-only calls for OTP therapy, counseling and periodic assessments"},{"key":"pone.0274094.ref018","article-title":"Nation\u2019s leading drug policy experts demand medication assisted treatment and COVID-19 treatment reforms","author":"C Boyd","year":"2020","journal-title":"R Street"},{"issue":"March","key":"pone.0274094.ref019","article-title":"Reimagining patient-centered care in opioid treatment programs: Lessons from the Bronx during COVID","volume":"122","author":"G Joseph","year":"2021","journal-title":"J Sub Abuse Treat"},{"key":"pone.0274094.ref020","doi-asserted-by":"crossref","first-page":"e257","DOI":"10.1097\/ADM.0000000000000718","article-title":"Early effects of COVID-19 on programs providing medications for opioid use disorder in jails and prisons","volume":"14","author":"S Bandera","year":"2020","journal-title":"J Addict Med"},{"key":"pone.0274094.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2021.109100","article-title":"Treatment provider perceptions of take-home methadone regulation before and during COVID-19","volume":"228","author":"EF Madden","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"pone.0274094.ref022","doi-asserted-by":"crossref","first-page":"292","DOI":"10.17730\/1938-3525-79.4.292","article-title":"Another silver lining?: Anthropological perspectives on the promise and practice of relaxed restrictions for telemedicine and medication-assisted treatment in the context of COVID-19","volume":"79","author":"ER Eaves","year":"2020","journal-title":"Human Organization"},{"key":"pone.0274094.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/11786329211037502","article-title":"Federally qualified health centers can expand rural access to buprenorphine for opioid users in Arizona","volume":"14","author":"BR Brady","year":"2021","journal-title":"Health Services Insights"},{"key":"pone.0274094.ref024","unstructured":"National Institute on Drug Abuse. Medications to treat opioid use disorder report: What is the treatment need versus the diversion risk for opioid use disorder treatment? [online]: https:\/\/nida.nih.gov\/publications\/research-reports\/medications-to-treat-opioid-addiction\/what-treatment-need-versus-diversion-risk-opioid-use-disorder-treatment Accessed April 25, 2022."},{"issue":"4","key":"pone.0274094.ref025","first-page":"54","article-title":"Improving health through community-based participatory action research","volume":"93","author":"KA Culhane-Pera","year":"2010","journal-title":"Minn Med"},{"key":"pone.0274094.ref026","author":"U.S. Centers for Disease Control and Prevention","year":"2022","journal-title":"Science Brief: Evidence used to update the list of underlying medical conditions associated with higher risk of severe COVID-19"},{"issue":"6","key":"pone.0274094.ref027","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/1468794115626244","article-title":"Enriching qualitative research by engaging peer interviewers: A case study.","volume":"16","author":"K Devotta","year":"2016","journal-title":"Qualitative Research"},{"key":"pone.0274094.ref028","unstructured":"USDA-ERS. [online]: www.ruralhealthinfo.org\/states\/Arizona accessed April 15, 2022."},{"key":"pone.0274094.ref029","unstructured":"U.S. Census Bureau. Arizona: 2020 Census. [online]: https:\/\/www.census.gov\/library\/stories\/state-by-state\/arizona-population-change-between-census-decade.html Accessed April 15, 2022."},{"key":"pone.0274094.ref030","unstructured":"U.S. Census Bureau. QuickFacts Arizona. [online]\u201d https:\/\/www.census.gov\/quickfacts\/AZ accessed May 6, 2022."},{"key":"pone.0274094.ref031","volume-title":"The CBHSQ Report","author":"C.E. Alderks","year":"2017"},{"issue":"9","key":"pone.0274094.ref032","first-page":"P799","article-title":"Mental disorders and risk of COVID-19 related mortality, hospitalization, and intensive care unit admission: a systematic review and analysis","volume":"8","author":"B Vai","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"pone.0274094.ref033","doi-asserted-by":"crossref","first-page":"108544","DOI":"10.1016\/j.jsat.2021.108544","article-title":"The impact of COVID-19 on substance use disorder treatment in California: Service providers\/ perspectives","volume":"133","author":"C Yin","year":"2022","journal-title":"J Sub Abuse Treat"},{"key":"pone.0274094.ref034","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s12954-021-00572-7","article-title":"Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives","volume":"18","author":"SV Aronowitz","year":"2021","journal-title":"Harm Reduction"},{"key":"pone.0274094.ref035","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3390\/healthcare9060663","article-title":"Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic","volume":"9","author":"A.W. Kang","year":"2021","journal-title":"Healthcare"},{"key":"pone.0274094.ref036","doi-asserted-by":"crossref","first-page":"108276","DOI":"10.1016\/j.jsat.2021.108276","article-title":"Take-home dosing experiences among persons receiving methadone maintenance treatment during COVID","volume":"123","author":"MC Figgat","year":"2021","journal-title":"J Sub Abuse Treat"},{"key":"pone.0274094.ref037","article-title":"The idea is to help people achieve greater success and liberty: A qualitative study of expanded methadone take-home access to opioid use disorder treatment","author":"LW Suen","year":"2021","journal-title":"MedRxiv"},{"issue":"108514","key":"pone.0274094.ref038","article-title":"Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms","volume":"132","author":"PC Treitler","year":"2022","journal-title":"J Sub Ab Treat"},{"key":"pone.0274094.ref039","article-title":"Outcomes associated with expanded take-home eligibility for outpatient treatment with medications for opioid use disorder: A mixed methods analysis","author":"OK Nguyen","journal-title":"medRxiv"},{"key":"pone.0274094.ref040","article-title":"Lessons learned from COVID-19 and regulatory change in the wake of necessity","author":"N. Krawczyk","year":"2022","journal-title":"Report to the National Academies of Science"},{"issue":"4","key":"pone.0274094.ref041","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1080\/00952990.2021.1903023","article-title":"Common themes in early state responses to substance use disorder treatment during COVID-19","volume":"47","author":"B Andraka-Christou","year":"2021","journal-title":"AM J Drug Alcohol Abuse"},{"key":"pone.0274094.ref042","unstructured":"Telehealth; Health Care Providers; Requirements, H.B. 2454, Arizona State Legislature (2021), https:\/\/legiscan.com\/AZ\/text\/HB2454\/id\/2391998."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274094","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T17:28:47Z","timestamp":1666718927000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274094"}},"subtitle":[],"editor":[{"given":"Kimberly","family":"Page","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0274094","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,25]]}}}