Narrative Review of Opioid Use Disorder Treatment Changes During the COVID-19 Pandemic and Their Impact on American Indian/Alaska Native Communities

Background: The United States (US) declared drug overdose a public health emergency in 2017. Despite this, two million people reported having an opioid use disorder (OUD) in 2018. However, following the beginning of COVID-19 there was a 53% increase in overdose deaths, with American Indian/Alaska Native (AI/AN) individuals experiencing the highest rates of all racial groups. In response to the COVID-19 pandemic and OUD treatment access challenges, OUD treatment policies were changed to improving access to care. Purpose: This review examines how the state- and federal-level policies impacted access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic. Due to the devastating impact of overdose and COVID-19 on AI/AN communities, as a secondary aim, we examined the inclusion of these populations in the samples of the included studies. Methods: We completed a narrative review using a data-based convergent synthesis design. Results: Forty-four studies met the inclusion criteria. Most of the studies were quantitative descriptive studies (n = 25). Only two studies offer AI/AN as a category for ethnicity and both had less that 4% of the sample that identified as an AI/AN individual. Conclusion and Implications: Telehealth OUD treatment increased initiation and retention for patients taking buprenorphine. No increase in overdose rates was associated with allowing for additional take-home doses of methadone. However, access to treatment, even telehealth, remains difficult for individuals due to a lack of OUD treatment providers and access to the internet. More needs to be done to address the opioid overdose crisis, especially among AI/AN communities. Research focused on cultural strategies to address this health disparity is desperately needed. We included nursing implications in response to this health disparity among AI/AN individuals.