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Opioid Drugs

COVID-19 and SUD an Especially Dangerous Combination

— March 26, 2020

Substance abuse and the coronavirus can be an especially lethal combination.

Experts are saying that those suffering from substance use disorder (SUD) are going to be impacted significantly by the coronavirus (COVID-19).  COVID-19 affects respiratory function, and researchers are suggesting, “People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.”  Plus, those who have substance use disorder (SUD) may be impacted by the mental health recuperations of the virus crisis, choosing to turn to substances to cope.

Thus far, it appears those who have been seriously impacted by COVID-19 have chronic conditions, such as diabetes, cancer, asthma and other respiratory ailments.  It is concerning that those with already compromised lung function or lung disease related to smoking, such as chronic obstructive pulmonary disease (COPD), could experience life-threatening symptoms if inflicted with the virus.

COVID-19 and SUD an Especially Dangerous Combination
Photo by Thom Masat on Unsplash

According to a case series published in JAMA based on data from the Chinese Center for Disease Control and Prevention (China CDC), “The case fatality rate (CFR) for COVID-19 was 6.3 percent for those with chronic respiratory disease, compared to a CFR of 2.3 percent overall.”  In China, “52.9 percent of men smoke, in contrast to just 2.4 percent of women.”  Vaping and cannabis use put individuals at high risk, too.  Since opioids slow breathing, their use by individuals with COVID-19 could cause a harmful decrease in oxygen in the blood (hypoxemia) and a fatal overdose.

A history of methamphetamine use may increase risk, because the drug constricts blood vessels, causing pulmonary damage and pulmonary hypertension over time.  Coupled with COVID-19, lung capacity may be too low to support sufficient breathing.  Researchers also found other risks for people with SUD include “decreased access to health care, housing insecurity, and greater likelihood for incarceration.”  They contend, “Homelessness or incarceration can expose people to environments where they are in close contact with others who might also be at higher risk for infections.”

Because the Centers for Disease Control and Prevention (CDC) is recommending measures to self-quarantine when infected and increase social isolation, the National Emergency Response for medication-assisted treatment has developed the following measures to keep both substance users and practitioners safe amid the COVID-19 crisis:

“Extend prescriptions of buprenorphine, including first buprenorphine prescriptions from the Emergency Department (ED) to the maximum length possible;

Month-long prescriptions are encouraged – including first buprenorphine prescriptions from the ED (for > 7-day prescriptions, check CURES);

Utilize pharmacy home delivery for buprenorphine especially for those in quarantine or with co-morbidities that put them at increased risk;

Reduce mandatory in-person visits to a minimum; minimize any in-person visits for urine drug screens and counseling;

Use text or phone, video if possible to communicate with patients wherever possible. In some cases, patients may be prescribed medications without a face-to-face visit;

All people who use drugs should be given naloxone, safe consumption supplies, and fentanyl test strips. Even those who are not ready to quit can receive buprenorphine to treat withdrawal.”


COVID-19: Potential Implications for Individuals with Substance Use Disorders

Immediately reduce person to person contact in MAT services

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