Lasting impacts: COVID19 and substance use disorder

The convergence of the opioid epidemic and the COVID-19 pandemic has created new health care challenges. What has been accomplished and what will the long-term effects be after the pandemic?

Lasting impacts: COVID19 and substance use disorder:

First, we would like to emphasize the importance of medications such as Methadone, Naltrexone, Suboxone, and Buprenorphine, along with mental health counseling and therapy as viable and evidence-based treatments for those suffering from substance use disorders. These treatments are the most effective in combating the opioid crisis when taken as prescribed, and without other medications such as benzodiazepines. Some of these medications, methadone, in particular, require patients to travel 5-6 times a week to receive their daily treatment. The issue, particularly in a time of a pandemic as we have seen with novel coronavirus, or COVID19, is that when these facilities are forced to close, individuals no longer have access to these extremely important medications. This requires every Opioid Treatment Program (OTP) to have the provisions and emergency protocols in place that allow all participants the ability to take home enough methadone during the period of social isolation. Typically, with take-home methadone, the privilege is earned as a person shows signs of improvement while in treatment. With the COVID19 pandemic, individuals who have never before earned that right, and even those that may have previously lost that privilege are now required to be responsible for their 2-4 weeks provisions of methadone. This is extremely dangerous and puts the lives of patients at an increased risk of overdose death, without also providing the opioid reversal medication naloxone, also known as Narcan to each patient taking home their treatment doses. As the Opioid Prevention Team for Baltimore City, providing Narcan for thousands of new patients is both a daunting and sobering task as we realize just how many people depend on these medications to lead normal, healthy lives. We have learned something extremely valuable during this pandemic about communities of individuals suffering from substance use disorder. The first thing is that limiting contact within these facilities was (is) a decision that was (is) vital to the survival of those with SUD, as they are at a higher risk of contracting the novel coronavirus. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke. People with opioid use disorder (OUD) and methamphetamine use disorder may also have an increased vulnerability to contracting coronavirus due to the effects of prolonged use of these drugs on respiratory and pulmonary health. Additionally, individuals with substance use disorders have an increased likelihood of experiencing homelessness. Circumstances such as this pose unique challenges regarding the transmission of the virus that causes COVID-19. It is imperative that we protect vulnerable populations during these challenging times, especially as we are expecting an increasing number of these global incidences.