What challenges have providers experienced in treating patients with opioid addictions remotely? 

Dr Christo: Much of treating addiction and the recovery process benefit from developing therapeutic relationships with patients. This occurs in person and over time. Supportive group therapy sessions can be extremely helpful in facilitating recovery as well. Remote interactions lack the more personal and intimate elements of being together with another person or group of people. Therefore, it can be more difficult to engage in treating addiction and establishing recovery measures.

Certainly, any hands-on therapy has been limited during COVID-19, but more centers have opened and are providing services once again.


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Do you have any recommendations for providers currently treating patients with pain disorders over the course of COVID-19?

Dr Christo: Many pain specialists are now seeing patients in person and via telemedicine. It’s important to offer both options. Telehealth has opened up access to pain care for many patients who are reluctant to attend an in-person appointment. The examination is limited, but we can still offer medication treatments, alternative therapies, and suggest possible procedural interventions (injections, nerve blocks) if patients later feel comfortable with in person treatments. It’s important for providers to realize that patients may be experiencing more intense pain due to the pandemic and offer support and encouragement that their worsening symptoms will improve.

What steps should providers take to address the needs of patients who may be at risk of developing an opioid addiction during this time?

Dr Christo: I would inquire into the patient’s individual risk factors of developing an opioid addiction (personal history of drug abuse, family history of drug abuse, co-existing mental health diagnoses such as depression, bipolar, etc), administer a risk assessment questionnaire, and be aware of any other concurrent medications that the patient is taking, which could increase overdose risk if combined with an opioid.

Make sure that the patient or family members have narcan available too. Offer the support of a mental health professional who specializes in addiction. Provide information about support groups as well.

What role does social isolation and the general disruption of routine play in worsening the opioid crisis?

Dr Christo: For those in recovery, a routine is paramount to maintaining sobriety. Routines consist of attending 12 step programs, exercise, regular counseling sessions, and personal contact with sponsors and trusted friends. It can also mean using agonist treatments such as suboxone and methadone in order to prevent relapse.

COVID-19 has led to the disruption of routines due to social isolation and confinement as well as a lack of assess to agonist therapies. Fortunately, teletherapy sessions have helped combat social isolation and some agonist therapies can be prescribed over the phone or via telemedicine.

Health literacy has been a challenge during the COVID-19 pandemic. Do you think the elevated visibility of medical experts in the media during this time has improved health literacy, and could that have implications for other public health concerns?

Dr Christo: I do believe that well-informed medical experts in the media can use their expertise to educate and inform a great number of people in a short period of time. That’s been quite helpful during the COVID-19 pandemic and can have the same positive impact on critical health matters of the future.

I’ve seen this myself when asked to share information about pain and addiction during the pandemic on both TV and radio. I’ve also found that a sustained presence as a medical expert in the media can improve the lives of those suffering from pain. For instance, many have said that my Sirius XM radio talk show called Aches and Gains (paulchristomd.com) has guided them to an array of treatments to ease their pain while providing hope from real people who have overcome their condition.

References

1. Grinspoon P. A tale of two epidemics: when COVID-19 and opioid addiction collide. Harvard Heath Blog. https://www.health.harvard.edu/blog/a-tale-of-two-epidemics-when-covid-19-and-opioid-addiction-collide-2020042019569 Published online April 20, 2020. Accessed September 28, 2020.

2. Petterson S, Westfall JM, Miller BF. Projected deaths of despair during the

Coronavirus recession. Well Being Trust. https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf  Published online May 8, 2020. Accessed September 28, 2020.

3. Silva MJ, Kelly Z. The escalation of the opioid epidemic due to COVID-19 and resulting lessons about treatment alternatives. Am J Manag Care. 2020;26(7):e202-e204. doi.org/10.37765/ajmc.2020.43386

4. Considerations for the care and treatment of mental and substance use disorders in the COVID-19 epidemic. March 20, 2020. SAMHSA.gov. https://www.samhsa.gov/sites/default/files/considerations-care-treatment-mental-substance-use-disorders-covid19.pdf Updated May 7, 2020. Accessed September 28, 2020.

5. Opioid overdoses on the rise during COVID-19 pandemic. EMS World. https://www.emsworld.com/news/Opioid-Overdoses-on-the-Rise-During-Covid-19-Pandemic Published online June 25, 2020. Accessed September 28, 2020.

6. Baumgartner JC, Aboulafia GN, Collins SR. The implications of COVID-19 for opioid-related mortality. To the Point (blog). https://www.commonwealthfund.org/blog/2020/implications-covid-19-opioid-related-mortality Published online August 28, 2020. Accessed September 28, 2020.

This article originally appeared on MPR