Imagine if in addition to being stressed about your finances, concerned about whether you’ll have a job next week and constantly wondering if you’ll become infected by COVID-19, you also have no idea if your opioid addiction treatment will be available when you need it.

These are the stressors many with an opioid use disorder deal with daily now and the results could be life-threatening.

“Stress is a known trigger for patients with substance use disorders and that’s the kind of thing that we’re really worried about: how is this increased stress going to affect their recovery and their management of their opioid use disorder and other substance use disorders?” said Yngvild Olsen, MD, MPH, medical director for the Institutes for Behavior Resources in Baltimore Maryland, ASAM vice president and chair of the Caring for Our Patients During COVID Taskforce.

Of course, it’s extremely important that opioid treatment programs (OTPs) remain open to dispense life-saving medications, such as methadone and buprenorphine. Dr. Olsen said they reduce mortality from opioid-related overdoses by 50 percent to 75 percent.

“If people lose access to those medications then their risk of experiencing withdrawal, relapse and a potential overdose related to that relapse go up significantly,” Dr. Olsen said.

With patients making frequent, sometimes daily visits to treatment programs for their medications, OTPs can quickly become hotspots for COVID transmission. Fortunately, SAMHSA and the DEA moved quickly in early March to allow for a transition to telehealth and larger amounts of medication to be dispensed to patients at one time to help lower the risk of virus infection.

During this time, many providers have found innovative ways to safely stay engaged with patients and to continue providing medications, counseling services and other forms of support during the pandemic. The usage of audio and visual telehealth platforms has dramatically increased. In most cases, this allows patients to receive care without leaving home. In some cases, patients and their providers meet in the same building but in different rooms using video telehealth platforms, Dr. Olsen said. In New York and possibly soon in Baltimore, alternative ways of delivering medicine are being explored so patients don’t have to visit clinics at all, especially if they are supposed to be isolating or in quarantine due to COVID-19 illness or exposure.

With physical distancing practices likely to continue for the foreseeable future, it’s important that patients feel assured that their OTP services will remain available. They also must know that OTPs are doing everything they can to ensure a continuity of medication and connectedness to counselors and recovery support systems.

“We understand that this is very stressful so it’s important that patients know we are here for them and that we will be here for them today, tomorrow and the next day,” Dr. Olsen said.

Six Things to Implement into the Procedures of Your Opioid Treatment Program

1. Infection control and mitigation procedures
2. Transitioning to telehealth whenever possible
3. Updated clinical procedures related to take home dosing, dosage changes via telehealth, drug testing, etc.
4. Process for reviewing staffing daily and modifying schedules if needed to effectively provide care
5. Communication with staff, patients, and caregivers
6. Tracking patient hospitalizations and adjusting care as needed

• Programs should be able to trach patient emergency department visits and hospitalizations in their state or local health information exchange (HIE)
• Programs may need processes in place to confirm hospital doses
• Programs should have processes in place to keep patients who have been hospitalized separate from other patients since the hospital poses a risk for COVID-19 exposure.

ASAM’s Guidance on Access to Care in OTP >>>