Lessons from COVID-19 for improving delivery of medications for opioid use disorder in future pandemic events: results from a Puerto Rico Delphi consensus panel

COVID-19 severely disrupted the provision of medications for opioid use disorder (MOUD) everywhere. Yet, while MOUD has proven to reduce mortality and other drug-related harms, no comprehensive guidelines exist to deliver treatment during a future pandemic. From June to November 2023, (N = 12) stakeholders with professional backgrounds in MOUD delivery and policy, including one patient located in San Juan, Puerto Rico, were recruited to deliver policy recommendations on pandemic preparedness. A Delphi consensus approach was employed in three rounds of consultations utilizing an anonymous Qualtrics survey format that included informed consent information. Panelists responded to an initial set of 26 statements across four domains: providing treatment, testing and vaccination, overdose prevention, and emergency preparedness which were revised based on ratings and narrative responses from each round. Consensus was reached on 22 statements, and panelists produced five majority recommendations. Panelists produced comprehensive guidance on policies to provide MOUD in a future pandemic, including recommendations that clinics provide testing and vaccination sites as soon as these resources become available and staff should receive training in emergency preparedness, including trauma-informed care and ventilator use. No consensus was reached regarding unsupervised take-home dosing or the mandatory requirement of testing and vaccination for patients and staff. The global prevalence of opioid use disorders and the urgent need for MOUD suggest that pandemic preparation policies for MOUD could benefit from a more coordinated international approach that avoids disruption of services especially for vulnerable patients living in poverty.