Commentary

Reducing COVID-19 opioid deaths

Current Psychiatry. 2021 January;20(01):20-24 | doi:10.12788/cp.0071

References

1. Volkow ND. Collision of the COVID-19 and addiction epidemics. Ann Intern Med. 2020;173(1):61-62.
2.Centers for Disease Control and Prevention. Overdose deaths accelerating during COVID-19. Accessed December 23, 2020. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
3.Centers for Disease Control and Prevention. National Center for Health Statistics Vital Statistics Rapid Release. Provisional drug overdose death counts. Accessed December 30, 2020. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
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13.American Medical Association. Issue brief: reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. Published October 31, 2020. Accessed November 9, 2020. https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf
14.American Society of Addiction Medicine. Caring for patients during the COVID-19 pandemic: ASAM COVID-19 Task Force recommendations. Accessed October 30, 2020. https://www.asam.org/docs/default-source/covid-19/medication-formulation-and-dosage-guidance-(1).pdf
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Strategies for intervention

A multi-dimensional approach is needed to protect the public from this growing opioid overdose epidemic. To address this challenging task, we recommend several strategies:

Enhance access to virtual treatment
Even when in-person treatment cannot take place due to COVID-19-related restrictions, it is vital that services are accessible to patients with SUDs during this pandemic. Examples of virtual treatment include:

Telehealth for medication-assisted treatment (MAT) using buprenorphine (recently updated guidance from the US DEA and Substance Abuse and Mental Health Services Administration [SAMHSA] allows this method of prescribing)
Teletherapy to prevent relapse
Remote drug screens by sending saliva or urine kits to patients' homes, visiting patients to collect fluid samples, or asking patients to come to a "drive-through" facility to provide samples
Virtual (online) Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, and similar meetings to provide support in the absence of in-person meetings.

The American Society of Addiction Medicine (ASAM) offers guidance to treatment programs to focus on infection control and mitigation. The Table¹⁴ summarizes the ASAM recommendations for office-based opioid treatment during COVID-19.

Expand access to treatment
This includes access to MAT (such as buprenorphine/naloxone, methadone, naltrexone, and depot naltrexone) and, equally important, to psychosocial treatment, counseling, and/or recovery services. Recent legislative changes have increased the number of patients that a qualified physician can treat with buprenorphine/naloxone from 100 to 275, and allowed physician extenders to prescribe buprenorphine/naloxone in office-based settings. A recent population-based, retrospective Canadian study showed that opioid agonist treatment decreased the risk of mortality among opioid users, and the protective effects of this treatment increased as fentanyl and other synthetic opioids became common in the illicit drug supply.¹⁵ However, because of the shortage of psychiatrists and addiction medicine specialists in several regions of the United States, access to treatment is extremely limited and often inadequate. This constitutes a major public health crisis and contributes to our inability to intervene effectively in the opioid epidemic. Telepsychiatry programs can bring needed services to underserved areas, but they need additional support and development. Further, involving other specialties is paramount for treating this epidemic. Integrating MAT in primary care settings can improve access to treatment. Harm-reduction approaches, such as syringe exchange programs, can play an important role in reducing the adverse consequences associated with heroin use and establish health care relationships with at-risk individuals. Syringe exchange programs can also reduce the rate of infections associated with IV drug use, such as human immunodeficiency virus and hepatitis C virus.

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Reducing COVID-19 opioid deaths

References

Strategies for intervention

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