In the rush to protect vulnerable populations from the COVID-19 pandemic, the risk to people struggling with addiction is especially high. And health professionals suggest this could undermine efforts to control the coronavirus spread.
According to experts, people who use drugs are doubly at risk during this epidemic, not only from overdose but also from increased risk of infection. Medical mobilization to address COVID-19 is leading to shifts in health care that may inadvertently make accessing treatment for addiction even harder, but according to leaders at the , a program dedicated to helping people with substance use disorders receive 24/7 high-quality care, there are new approaches that can help people get treatment during the pandemic.
“It’s more important than ever that people addicted to opioids or other drugs are given medication for addiction treatment (MAT). Unless treated, they may go into withdrawal or risk overdose, thereby increasing the chances of spreading the virus within their high-risk populations and to the health care workers who treat them,” says Dr. Hannah Snyder, primary care and addiction medicine specialist at Zuckerberg San Francisco General Hospital, and a principal investigator for the CA Bridge program.
In the effort to address coronavirus, experts at CA Bridge worry that the critical needs of people experiencing drug addiction are being ignored, exacerbating an already difficult containment challenge. To support physical distancing and prevent withdrawal, Dr. Snyder suggests providing care by phone, providing longer prescriptions for buprenorphine (a drug commonly used to treat opioid addiction) and delivering medications to patients whenever possible. The alternative, requiring patients with addictions to visit their clinics or hospitals for daily or weekly prescriptions refills, is unsustainable in the present climate of stay-at-home orders and social distancing.
According to Dr. Snyder, most of this care can be provided through telehealth techniques to prevent exposing patients to health care environments, and to protect health workers and the general population from exposure. Telehealth regulations are currently being broadened during this public health emergency to help ensure patients maintain a reliable source of medications while limiting face-to-face interactions.
Health experts agree that it’s essential to continue medications for opioid and other substance use because if MAT is stopped suddenly, patients will go into withdrawal, experiencing often intolerable physical and psychological symptoms. "There's no way you can sit at home and endure this. Everything about the way the human brain and body works will prioritize seeking relief, whether that means showing up in a crowded ER or finding drugs on the street,” says Serena Clayton, PhD, CA Bridge program director.
Quarantine and isolation put people who use drugs at high-risk for withdrawal. Another potential danger is that social distancing may increase the likelihood of overdose. That’s why Snyder recommends that all people who use drugs or are on MAT should be given naloxone and fentanyl test strips to help prevent overdose.
Additionally, CA Bridge recommends that patients be encouraged to use harm reduction principles and good hygiene. For people who are not yet ready to start medication treatment, harm reduction, such as clean drug consumption supplies, naloxone, fentanyl strips and remote monitoring for overdose, can be lifesaving.
Because the situation is rapidly changing and sharing information about COVID-19 in relation to this patient population is urgent, the CA Bridge program continues to update best practices and key steps. More technical recommendations and resources can be found on the CA Bridge website at www.bridgetotreatment.org.