Publication date: May 24, 2020
For those who experience addiction and mental health concerns, the additional stress can pose a serious risk to health — especially in the midst of an opioid crisis in North America.
Prior to COVID-19, people with opioid addiction already struggled to obtain comprehensive care due to widespread stigma and misinformation, in addition to systemic and socioeconomic barriers.
Now, a health dilemma is afoot: The rightful and necessary need to respect physical distancing has unfortunately also resulted in social isolation and increased levels of stress for many people, including those who use opioids.
The current situation is quickly producing additional barriers to accessing evidence-based care: such as pharmacotherapy, psychotherapy, harm reduction services, addiction medicine, and social supports.
These medications, known as opioid agonist therapies (OATs), maintain tolerance, improve treatment retention, reduce risk of relapse, and importantly, reduce overdose risk compared to abstinence only-based approaches to opioid addiction treatment.
These stigmatizing beliefs are inaccurate, cheapen the complexity of addiction treatment, and discourage people from seeking evidence-based care.
It is estimated that 50%-75% of people who experience addiction — including opioid addiction — meet criteria for one or more mental health disorders, such as post-traumatic stress disorder, anxiety, and depressive disorders.
The benefits from treatment in opioid addiction are more likely to happen when people receive integrated treatment for both addiction and mental health at the same time.
In many geographical areas, few evidence-based treatment options exist for people who use opioids.
People with opioid addiction who are prescribed OATs are more likely to be abstinent from illicit opioid use in comparison to placebo or programs where no medication is offered.
This is problematic because if a person subsequently relapses to opioids, then they are at serious risk for health complications, particularly if they use the same dose of opioids that they used prior to starting the treatment program.
Several approaches can be taken to improve access to evidence-based treatment for opioid addiction, such as OATs.
We suggest exploring a number of adaptations to standard care: removing witnessed doses, which can reduce cost and improve retention to treatment; temporarily stopping the use of urine drug screening; and allowing people to begin the use of buprenorphine/naloxone at home in collaboration with their physician — known as home induction.
These changes strike a balance between evidence-based opioid treatment and respect for physical distancing, with a view towards reducing the risk of viral spread to our most vulnerable populations.
|disease||MESH||post-traumatic stress disorder|