Ukrainian refugees face high barriers to opioid use disorder treatment

The most effective treatment to care for people with opioid use disorder are opioid agonist therapies (OAT), including medications like methadone or buprenorphine. But interrupting this therapy may result in severe symptoms of withdrawal, relapse to injected opioids, overdose, and death.

Unfortunately, many Ukrainian refugees fleeing the war have encountered obstacles when seeking these therapies in European Union countries, a new Yale-led study finds. The study examines the barriers to opioid agonist therapies and providers' responses to increased demand in OAT enrollment after the Ukrainian refugee crisis.

An estimated 360,000 people who inject drugs reside in Ukraine, and 20% of them have HIV. Ukraine's intertwined opioid and HIV epidemics are among the most severe in Europe.

"Ukraine has the second highest HIV prevalence in all of Europe, concentrated in people with opioid use disorder," said Yale undergraduate researcher Benjamin Nikitin, first author of the new publication in PLOS Global Public Health. "Opioid agonist therapies are critical to eliminating that risk of HIV transmission, as they can be taken orally rather than through injection."

Nikitin, a first-generation Ukrainian American, traveled to Poland with Yale School of Public Health (YSPH) doctoral candidate Daniel Bromberg, where they interviewed Ukrainian refugees with opioid use disorder to uncover the barriers to accessing treatment while displaced. The two researchers also completed interviews with refugees and OAT providers in Germany, Czechia, Slovakia, Romania, and Hungary.

In the study, researchers found that networks among OAT providers were not effectively leveraged to respond to the emergent refugee crisis. "We wanted to see if providers were communicating with one another or if they were 'reinventing the wheel' in isolation from feedback and problem-solving with their colleagues," said Nikitin.

The study suggests that collaborative learning between providers, facilitated through an easily adaptable framework like the Network for the Improvement of Addiction Treatment (NIATx), could be used in EU countries to overcome barriers observed early in the conflict.

Senior author Frederick Altice, MD, professor of medicine, Yale School of Medicine, and of epidemiology, YSPH, said, "NIATx is an implementation tool that aims to increase quality performance and create rapid-cycle changes so that behavioral health care settings can respond to emergencies and increase access to treatment. It helps them assess emerging barriers immediately and respond to the most important ones. NIATx might be successfully leveraged to address other emerging crises, similar to what was done within Ukraine and reported in another publication."