Abstract

Background: The coronavirus disease (COVID-19) pandemic has impacted patients receiving methadone maintenance treatment (MMT) through opioid treatment programs (OTPs), especially because of the unique challenges of the care delivery model. Previously, documentation of patient experiences during emergencies often comes years after the fact, in part because there is a substantial data void in real-time. Methods: We extracted 308 posts that mention COVID-19 keywords on r/methadone, an online community for patients receiving MMT to share information, on Reddit occurring between January 31, 2020 and September 30, 2020. 215 of these posts self-report an impact to their MMT. Using qualitative content analysis, we characterized the impacts described in these posts and identified four emergent themes describing patients’ experience of impacts to MMT during COVID-19. Results: The themes included (1) 54.4% of posts reporting impediments to accessing their methadone, (2) 28.4% reporting impediments to accessing physicial OTPs, (3) 19.5% reporting having to self-manage their care, and (4) 4.7% reporting impediments to accessing OTP providers and staff. Conclusions: Patients described unanticipated consequences to one-size-fits-all policies that are unevenly applied resulting in suboptimal dosing, increased perceived risk of acquiring COVID-19 at OTPs, and reduced interaction with OTP providers and staff. While preliminary, these results are formative for follow-up surveillance metrics for patients of OTPs as well as digitally-mediated resource needs for this online community. This study serves as a model of how social media can be employed during and after emergencies to hear the lived experiences of patients for informed emergency preparedness and response.

摘要

背景：冠状病毒病 (COVID-19) 大流行影响了通过阿片类药物治疗计划 (OTP) 接受美沙酮维持治疗 (MMT) 的患者，尤其是因为护理提供模式的独特挑战。以前，紧急情况下患者经历的记录通常是事后数年，部分原因是实时存在大量数据无效。方法：我们在 2020 年 1 月 31 日至 2020 年 9 月 30 日期间在 Reddit 上提取了 308 篇在 r/methadone 上提及 COVID-19 关键字的帖子，这是一个供接受 MMT 的患者分享信息的在线社区。其中 215 篇帖子自我报告对他们的 MMT。使用定性内容分析，我们描述了这些帖子中描述的影响，并确定了四个紧急主题，描述了患者在 COVID-19 期间对 MMT 的影响体验。结果：主题包括 (1) 54.4% 的帖子报告在获取美沙酮方面存在障碍，(2) 28.4% 的帖子报告在获取物理 OTP 方面存在障碍，(3) 19.5% 的帖子报告必须自行管理护理，以及 (4) 4.7 % 报告访问 OTP 提供者和员工的障碍。结论：患者描述了对一刀切政策的意外后果，这些政策应用不均，导致剂量不理想，增加了在 OTP 获得 COVID-19 的感知风险，并减少了与 OTP 提供者和工作人员的互动。虽然是初步的，但这些结果对于 OTP 患者的后续监测指标以及该在线社区的数字中介资源需求具有形成性。这项研究作为一个模型，说明如何在紧急情况期间和之后使用社交媒体来听取患者的生活经历，以便进行知情的应急准备和响应。