For professionals in the healthcare sector that work with people who use substances there are unique considerations due to the COVID-19 public health emergency. Some of these include:
- Potential medication shortages,
- Pharmacy disruption to dispensing
- Patient illness or quarantine
The existing evidence base about COVID-19 and its intersection with substance use disorders is limited. Fortunately, there are some measures in place for those who work with people who use substances. COVID-19’s impact on the ongoing opioid overdose crisis means that healthcare professionals must support clients to address these two significant health crises.
Frequently Asked Questions
People who use substances may be at an increased risk of COVID-19 due to a number of physical and/or social and environmental reasons.
- They may have comprised health as a result of their use, including smoking and vaping, but use of opioids and methamphetamine are also a concern because of the effects these drugs have on respiratory and pulmonary health.
- Opioids slow breathing and have already been shown to increase mortality in people with respiratory diseases - reduced lung capacity from COVID-19 could be a problem.
- Methamphetamine has been shown to produce significant pulmonary damage and this will likely increase the risk of negative outcomes if used during a COVID-19 infection.
- Vaping, like smoking, may also harm lung health, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and reduces the ability to fight infection. (National Institute on Drug Abuse, 2020).
Access to prescription medications may be limited during this time. So it is important to work with clients, especially those that are taking Opioid Agonist Therapies (OAT), such a methadone and buprenorphine. New interim guidelines (March 22, 2020) for management of OAT address office visits, remote visits, carry doses, and frequency of urine drug testing during the COVID-19 pandemic. For additional guidance visit: www.metaphi.ca (METPHI/OMA, March 22, 2020).
Some professionals will provide tele-rehabilitation (using technology to access physiotherapy services at a distance when an in-person visit is not possible), but there are also some on-line and self-help resources available to patients to utilize to manage chronic pain without the use of opioids or other pharmacological therapies.
A patient who screens positive or is in self isolation should have someone from outside of their household to pick up their medications or the pharmacy should arrange for the delivery of medications.
Health Canada’s policy position Transportation of Controlled Substances in Canada permits pharmacists to transport controlled substances to patients with an appropriate prescription. During COVID-19 The Office of Controlled Substances has issued a short-term subsection 56(1) exemption from the Controlled Drugs and Substances Act (Health Canada, March 23, 2020). Subject to the laws and regulations of the province in which the pharmacist is entitled to practice, this exemption will authorizes pharmacists to:
- Prescribe, sell, or provide controlled substances in limited circumstances,
- Transfer prescriptions for controlled substances.
In Ontario, a pharmacy owner or designated manager should determine the most appropriate process, considering the particulars of the medication with respect to security and storage and articulate this process to the pharmacy team. For further guidance please review Ontario Pharmacy Association’s COVID-19: A Pharmacist’s Guide to Pandemic Preparedness
Healthcare providers in RAAM clinics are encouraged to make modifications. Here are some recommendations from the network of RAAM clinic administrators and care providers across Ontario (META:PHI, 2020).
- See already-connected patients over OTN or telephone.
- Perform screening tests at the door, and see patients who screen positive through a protective barrier (e.g., a mask, a window, etc.).
- Provide masks to all patients who do not already have one.
- Increase the distance between seats in the waiting room.
- Ask patients with both cell phones and cars to wait in their cars rather than in the waiting room, and call or text them when it is their turn to be seen.
- Extend prescriptions for stable patients.
- Dedicate additional hours to booked appointments with walk-in patients who cannot be seen during regular walk-in hours due to limited space and capacity.
- Patients and clients should be advised to practice good hand hygiene, respiratory etiquette (e.g., sneezing into a bent elbow or disposable tissue), and to practice social distancing as much as possible and maintain a distance of 2 meters from other people.
- Patients and clients should be advised of virtual recovery options. Social connectedness is a key part of recovery from substance use for many people. Twelve step programs like Alcoholics Anonymous have physical meetings that people are encouraged to attend in person. Now that people are practicing social distancing and self-quarantining, to limit the spread of COVID-19, virtual resources are essential.
- Additional Web Resources for People Who Use Substances
Resources for Healthcare Providers
- COVID-19: A Pharmacist’s Guide to Pandemic Preparedness
- COVID-19: Interim Guidance for Primary Healthcare Providers of PWUD - WECHU
- COVID 19: Interim Guidance for Pharmacists - WECHU
- Health Canada: Practitioners and Pharmacists Prescribing and Providing Controlled Substances in Canada during the Coronavirus Pandemic
- COVID-19 Patient Screening Guidance Document - Ontario Ministry of Health
- COVID-19 Provincial Testing Guidance Update - Ontario Ministry of Health
- Guidance for Pharmacies - Ontario Ministry of Health
- META:PHI/OMA - COVID-19: Opioid Agonist Treatment Guidance
- Managing Stress, Anxiety and Substance Use during Covid-19: A Resource for Healthcare Providers
- SAMSHA’s Virtual Recovery Resources
- WECOSS Safer Drug Use to Help Prevent against COVID-19 factsheet