BACKGROUND: Organizational responses to crises can profoundly impact the operations and functioning of programs. Specifically, the COVID-19 pandemic led to an 18% increase in drug overdoses and necessitating significant protocol adjustments. We examined opioid treatment programs (OTPs) responses to the pandemic, and associations with clients' perceptions of COVID-19 concerns and perceptions of effect and overall impact.

METHODS: Data from 2023 encompassing 92 OTPs and 435 client surveys were analyzed using multilevel regression models. Dependent variables measured clients COVID-19 exposure concerns, and perception of the pandemic's broader impact. Independent variables included types of response, staff composition, funding, and accreditation.

RESULTS: Clients in programs with higher proportions of African Americans, 1.02 (95% Confidence Interval CI = 1.00-1.03) or Latino staff, 1.03 (CI = 1.01-1.04) expressed significantly greater concern about COVID-19 exposure. Conversely, clients in publicly funded programs reported significantly lower concern about exposure, 0.37 (CI = 0.15-0.90). On the other hand, programs with more administrative responsiveness, 1.44 (CI = 0.07-2.80), or accreditation by the Commission on Accreditation of Rehabilitation Facilities, 1.90 (CI = 0.13-3.67), were associated with significantly higher perceived overall impact of the pandemic, respectively.

CONCLUSION: This study highlights the intricate connection between program characteristics and organizational responses during public health crises. Our findings underscore the importance of culturally sensitive approaches and effective communication to address client COVID-19 concerns and perceptions, particularly within disproportionately affected minority communities. These insights emphasize the necessity for OTPs to adapt to meet the evolving needs of clients, ensuring that they receive the support and care required during uncertainties.