Prior to the advent of the coronavirus disease 2019 (COVID-19) pandemic, the opioid epidemic had been sweeping through the United State. An opinion piece recently published in the Annals of Internal Medicine highlights growing concerns among medical professionals about the exacerbating effects the pandemic may have among people with opioid use disorder (OUD).
Job loss, food insecurity, and overall morbidity have disproportionately affected marginalized communities, including people with medical and psychiatric comorbidities. This has left the medical community with concerns about the potential rise in substance use disorders and opioid overdose. In the published opinion piece, William C. Becker, MD and David A. Fiellin, MD, explore the importance of uninterrupted access to methadone and buprenorphine for patients with OUD.
For quarantined patients, mobile teams were suggested as a way to deliver methadone, considering physical examination requirements have been relaxed and extended supply of the medication for stable patients has been allowed. The authors also encouraged the use of settlement funds from a buprenorphine manufacturer to address limited access to the drug due to financial constraints. The safer pharmacologic properties of buprenorphine allow it to be dosed less frequently, and in-home initiation of the drug is now supported by new dose titration protocols.
Currently, first year clinicians are required to limit the number of patients they treat concurrently; however, authors suggest this restriction be temporarily lifted in order to compensate for the limited number of physicians available due to the COVID-19 crisis, and support networks should be funded from local, state and federal governments to address patient needs.
In addition to highlighting the importance of uninterrupted access, the authors also implore the federal government to maintain funding for opioid-related projects, as the race for a COVID-19 vaccine threatens to halt strides in research on OUD treatment.
Finally, medical professionals are concerned that COVID-19 may delay remunerations for families affected by the opioid crisis. Financial insecurity due to the crisis makes it increasingly important to facilitate the acceleration of cases nearing resolution, because the postponement of court hearings in the era of social distancing may delay the compensation of victims of opioid manufacturers’ malfeasance.
“The response to COVID-19 and the speed with which regulatory barriers are being reconsidered and removed should be translated to opioid-related clinical, research, and legal policy”, the opinion authors noted. “In the absence of such efforts, we risk more catastrophic effects from these colliding epidemics.”
Becker, W. C, MD, Fiellin, D. A, MD, When epidemics collide: coronavirus disease 2019 (covid-19) and the opioid crisis [published online April 2, 2020]. Ann Intern Med. doi: 10.7326/M20-1210