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COVID-19 and Substance Use Disorder: Getting Your Patients Back to Care

Physicians who treat patients with chronic pain may need to work even harder to keep their patients safe during the COVID-19 pandemic, according to experts at Quest Diagnostics. The same is true for those with patients with substance use disorder (SUD) or mental health conditions. Medication overuse or excess alcohol consumption is a risk, and medication adherence may be a challenge that physicians must face squarely during these trying times.

Those messages came through clearly in a recent webinar given by Jeff Gudin, MD, Senior Medical Advisor, Drug Monitoring & Toxicology; Jack Kain, MD, Director, Medical Science Liaison, Drug Monitoring & Toxicology; and Nicholaos Bellos, MD, Medical Director-Total Quality Management.

The coronavirus pandemic has heightened anxiety and concern among all people, Dr Gudin noted, with stress induced by loss of work, risk of illness, and worry about loved ones. Patients being treated for pain or SUD during the pandemic may need closer monitoring than usual to keep them healthy and away from medication misuse.

“These events can increase the risk of substance abuse, such as extensive drinking or drug use, as a coping mechanism,” Dr Gudin said. The risk for substance abuse is likely to vary based on predisposing factors, including depression, anxiety, chronic pain, and SUD. “During this public health crisis, clinicians should be committed to monitoring not only patients’ physical conditions, but their mental status as well.”

The evidence that psychological issues and substance abuse increases during fraught times such as these is clear from previous disasters, such as the aftermath of Hurricane Katrina, which resulted in a 35% increase in hospitalizations for alcohol use, according to the Centers for Disease Control and Prevention (CDC).1

There are important coping mechanisms for patients during this period, and physicians can help reinforce helpful behaviors while helping patients avoid harmful ones. Recommendations include limiting exposure to news, eating healthy meals, getting enough sleep, and practicing deep breathing or other relaxation techniques. As well, Dr Gudin said, “While using appropriate social distancing practices, connect with others. Talk with people you trust about how you are feeling.”

It is important to not change medication recommendations for the chronic pain patient during a crisis such as this one, he said, a recommendation echoed by the American Society of Regional Anesthesia.2 Ensuring continued access to prescription medication is equally important, despite the added difficulty of refilling prescriptions during times of lockdown and social distancing.

“Social distancing is a risk factor for medication nonadherence,” Dr Kain noted. “Those patients suffering from a substance use disorder, particularly those who are enrolled in an outpatient opioid treatment program, need to balance the critical need to maintain social distancing with the equally critical need to obtain the necessary medication-assisted treatment for their disorder.”

Because of the increased stress during the pandemic, even patients who have used their medications appropriately are at risk for misuse. While the state-level prescription drug monitoring programs can indicate whether a patient has obtained a prescribed medication, it can’t tell whether the medication has been consumed appropriately. “Drug testing provides objective information on medication compliance, empowering behavioral health clinicians and treatment teams to make more informed decisions that can improve patient care,” stated Dr Kain.

For patients who come in to the clinic, appropriate protocols can keep patients and staff safe. The CDC has created a set of procedures that help reduce risk, including preparing the waiting room and office, screening patients before entry, providing masks and other equipment, and frequent cleaning.3

Quest has additional resources for physicians, available at https://www.questdrugmonitoring.com/resources#COVID-19-Resources

1Moise IK, Ruiz MO. Hospitalizations for Substance Abuse Disorders Before and After Hurricane Katrina: Spatial Clustering and Area-Level Predictors, New Orleans, 2004 and 2008. Prev Chronic Dis 2016;13:160107. https://www.cdc.gov/pcd/issues/2016/16_0107.htm

2Shanthanna H, Cohen SP, Strand N, et al. Recommendations on chronic pain practice during the COVID-19 pandemic. A joint statement by American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA). Updated March 27, 2020.https://www.asra.com/page/2903/recommendations-on-chronic-pain-practice-during-the-covid-19-pandemic

3Centers for Disease Control and Prevention. Get Your Clinic Ready for Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinic-preparedness.html