Patients with opioids use disorders (OUDs) constitute a highly vulnerable population group. Indeed, the restriction and social distancing measures adopted by societies to decelerate COVID-19 pandemic significantly affect their lives through intensifying medical and psychiatric co-morbidity (Volkow, 2020; Williams et al., 2021). This global public health crisis has induced serious changes in the implemented programs of medication-assisted treatment (MAT), since it led to crucial modifications in the delivery of medical care and in the regimen (i.e., management and administration) of medication for opioid use disorders (MOUD) (Chan et al., 2022; Treitler et al., 2022). In particular, there has been observed a trend by the OUDs patients to offer and buy illicit substances from black market (Baillargeon et al., 2021), thus altering the management of MOUD with craving and misuse being the most serious outcomes (Lambert, 2020). Moreover, economic and health disparities, inadequacy of supportive environment, homelessness, imprisonment, psychological trauma, stigma, and barriers that impede access to treatment due to restrictive measures have resulted in the adoption of unsafe practices that disturb management and administration of MOUD (Vasylyeva et al., 2020). Consequently, relapse to opioids and further impairment of the already problematic quality of life of OUDs patients have been observed, however reliable tools for the assessment of such situations under extreme periods, such as the COVID-19 pandemic crisis are lacking (Leventelis et al., 2020a; Tyndall, 2020).
Several uni-and multidimensional scales and tools have been developed to describe and assess specific problems on the procedure of substance use, such as the desire for using, the disorders due to use or the severity of health problems contributed to substance use (Marsden et al., 1998; McLellan et al., 1992; Tiffany et al., 1993). However, in most of the cases, the existing tools fail to include in their evaluation all potential dimensions of human behavior (Terwee et al., 2007). Regarding the impact of the pandemic on mental health, diverse tools have been developed for the assessment of psychological destruction (Akan, 2022), fear (de Almeida et al., 2020), anxiety (Chandu et al., 2020), preventive behaviors (Chang et al., 2022), the impact of event (Vanaken et al., 2020) and the quality of life (Repišti et al., 2020). Referring to patients with OUDs under MAT, most of the available studies have been focused mainly on the description of the emotional states of the patients affected by COVID-19, creating tools for the detection of worries or fear (i.e., the COVID-19 Worry Index and the Fear of COVID-19 scale), or to assess the forces that promote motivation to substance use (Rogers et al., 2020). Other tools have been built to measure COVID-19-related anxiety and depression (Adinolfi et al., 2021), as well as symptoms of anxiety and depressive disorders, suicidal attitude and substance use disorders due to COVID-19 (Czeisler et al., 2020).
However, the need for the development of a questionnaire that will consider the alterations in the MAT programs dictated by the pandemic through the incorporation of the appropriate and accurate questions is indisputable. The above-mentioned alterations were implemented under the concept that spread of COVID-19 should be prevented also in MAT programs to protect the members of the vulnerable population that attend them. Towards this direction, specific adjustments in the MAT administration procedures were made. The most important of them were the confinement of the daily face to face visits of the patients to the MAT programs to take their medication, the enhancement of the number of the take-home doses (i.e., 15 or 30 take-home doses, thus the patients visit the MAT programs only once or twice a month), the reduction of the frequency of drug urine screening for toxic substances and the constraint of the services that offer psychosocial support to the patients (Corace et al., 2022; Del Pozo & Rich, 2020; Harris et al., 2022; Nunes et al., 2021).
All these changes may negatively affect the procedure of successful maintenance treatment, thus preventing rehab via increase of craving. Interestingly, methadone and buprenorphine, along with counseling and psychosocial services offered by MAT programs, aim to the high adherence of patients to treatment. In parallel, this MAT practice intends to reduce illegal substance use and overdose mortality rates, as well as to inhibit aggressive and drug-seeking behaviors (Joseph et al., 2021; Treitler et al., 2022). Notwithstanding, because of the loosening of the regulations on MOUD attributed to COVID-19 measures, concerns regarding the diversion of opioids into the black market and the potential surge of harmful health consequences from misuse and overdose of prescribed medications have emerged (Del Pozo & Rich, 2020; Nagelhout et al., 2017; Nunes et al., 2021). To our knowledge, there is no available tool regarding the assessment of the impact of COVID-19 pandemic on the management and administration of MOUD and on several health and social parameters that pertain to MAT patients as evaluated by the patients themselves (Harris et al., 2022). This is an important matter, since examined from the patient perspective, a major context for the observed impact of the pandemic-related changes on mental and clinical parameters could guide research and public health policies to address specific issues as they have been stressed by the patients themselves (Harris et al., 2022). In that end, the main objective of the present study was the development and validation of the PANdemic Medication-Assisted Treatment Questionnaire, i.e., PANMAT/Q, an instrument for the management and administration of MOUD, namely methadone and buprenorphine, in patients under MAT programs. It is expected that such a questionnaire, which is oriented toward patients under MOUD, will offer valuable insight concerning the impact of restriction measures applied globally in the COVID-19 era, as well as in similar crises that will potentially arise in the future, on the trajectory to retention to maintenance treatment and, finally, rehab and social reintegration.