Using a structural vulnerability framework to understand the impact of COVID‐19 on the lives of Medicaid beneficiaries receiving substance use treatment in New York City

OBJECTIVE: To investigate how the COVID‐19 pandemic impacted low‐income individuals with substance use disorder (SUD) in New York City (NYC) during the beginning of the pandemic, using a structural competency and structural vulnerability theoretical framework and a qualitative research approach. DATA SOURCES: Primary qualitative data were collected from racial/ethnic minority adults enrolled in Medicaid receiving outpatient substance use treatment (e.g., medication, counseling) in NYC. STUDY DESIGN: Semi‐structured in‐depth qualitative interviews (N = 20) were conducted during “stay‐at‐home” orders in NYC, the first epicenter of the COVID‐19 pandemic in the United States. Interviews were conducted over the phone during the earlier stages of the pandemic, between April 2020 and June 2020. DATA COLLECTION/EXTRACTION METHODS: Semi‐structured in‐depth interviews were conducted and audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS: Three themes were yielded from our thematic analysis: (1) COVID‐19 heightened food insecurity and housing conditions increased risks of infection; (2) stay‐at‐home orders limited access to resources but had positive impacts in strengthening social relationships and reducing substance use triggers; and (3) although COVID‐19 created challenges for treatment, most described that SUD care improved during the pandemic. CONCLUSIONS: While COVID‐19 exacerbated numerous structural vulnerabilities among low‐income individuals with SUD, programmatic adaptations to COVID‐19 SUD care, including telehealth and loosening restrictions around medications for opioid use disorders mitigated past difficulties that patients had faced. Reducing structural vulnerabilities for Medicaid patients will require continuation of telehealth treatment delivery, retaining flexible medication regulations, and mobilizing community resources to mitigate economic disparities.