Longitudinal trends in service utilisation of alcohol and other drugs services (AODS) during COVID-19: A scoping review

Background: COVID-19 has affected service delivery and utilisation of Alcohol and Other Drugs Services (AODS) worldwide with a potential negative impact on service users. Objectives: To understand the trends of service utilisation of AODS during COVID-19 (2019-2022), identify knowledge gaps, and provide directions for future research and planning. during COVID-19. Methods: Five databases and grey literature were searched for quantitative studies on service utilisation of AODS during COVID-19. After de-duplication of 1546 articles, 938 were screened and 43 underwent full-text review. Data extracted from 30 studies informed this review. Results: Twenty-eight studies were from high-income countries and 15 focused on medication for opioid use disorders (MOUD). An initial reduction of service utilisation followed by gradual improvement was seen in most treatment types. The greatest disruptions were seen in residential programs, outreach services, home visits, group therapy and needle syringe programs (NSP) with fewer disruptions in individual counselling and MOUD. Although treatment initiations decreased, improved treatment adherence was noted. This was linked to increased flexibility in accessing MOUD and NSP. An increased tendency to use the buprenorphine long-acting injection (LAIB) was also evident. Telehealth and policy changes were associated with improved service utilisation. Telehealth contributed to catchment expansion and broadening of service-user profiles. Conclusions: Findings from a few high-income countries show that the impact of COVID-19 on AODS changed over time according to factors such as service modifications, drug/treatment type and geographical remoteness. Policy changes, telehealth, and newer treatment modalities minimised disruptions and should be effectively adapted during the post-COVID period. Global studies on longitudinal trends and outcomes, and regional/rural services are recommended.