COVID-19 and substance use disorders: a review of international guidelines for frontline healthcare workers of addiction services

Abstract

Background People with substance use disorders may be at a greater risk of contracting COVID-19 infection and developing medical complications. Several institutional and governmental health agencies across the world developed ad hoc guidance for substance use disorder services and care of individuals misusing substances. We aimed to synthesise the best available recommendations on management and care of people with or at risk of substance use disorders during the COVID-19 pandemic from existing guidelines published in UK, USA, Australia, Canada, New Zealand, and Singapore. Methods We systematically searched existing guidelines and websites from 28 international institutions and governmental bodies in the context of the COVID-19 pandemic (May 4th 2021). We summarized the extracted data as answers to specific clinical questions. Results We organised the available recommendations from 19 sources in three sections. First, we focused on general advice and recommendations for people who misuse alcohol or drugs during the COVID-19 pandemic, the design of contingency plans, safeguarding issues for children and families of service users and advice to the public, patients, and carers. Then, we summarised specific guidelines for people who use illicit drugs and related services, such as opioid substitution treatment and needle and syringe programmes. Finally, we provided a synthesis on specific recommendations for services supporting people who misuse alcohol and key topics in the field, such as management of alcohol detoxification and safe transition between supervised and unsupervised consumption. Conclusions Available guidance reflected different approaches, ranging from being extremely cautious in providing recommendations other than generic statements to proposing adaptation of previously available guidelines to confront the challenges of the COVID-19 pandemic. After the early phase, guidance focused on reduction of infection transmission and service delivery. Guidance did not provide advice on infection prevention via vaccination programmes and service access strategies tailored to individuals with substance use disorders.

Strategies to maintain recovery from alcohol problems during the COVID-19 pandemic: Insights from a mixed-methods national survey of adults in the United States

“…In terms of other practice implications, several of our participants’ strategies align with recommendations for providing services to substance-using populations during the COVID-19 pandemic that were identified in a recent review [ 60 ]. For example, the common strategy of staying connected to maintain one’s recovery is reflected in recommendations to “create a buddy and self-support system with someone trusted and to reach out for extra help if needed.” In addition, several other qualitative themes emerging from this study are reflected in recent recommendations for services to substance-using populations (e.g., maintaining normalcy and a routine; drawing upon general social support and peers in recovery; using mutual-help groups).…”

Patterns of Opioid and Non-Opioid Analgesic Consumption in Patients with Post-COVID-19 Conditions

“…Hence, it is critical to educate society about the consequences of unauthorized opium consumption. Ostinelli et al synthesized the best available recommendations on the management and care of individuals at risk of substance use disorders during the COVID-19 pandemic and observed that current guidance does not provide advice on service access strategies tailored to individuals with substance use disorders [53].…”

Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation

“…Initially we focused on immediate priority areas. The rapid transition to telepsychiatry services [ 17 , 18 ] prompted the need for guidance syntheses regarding digital approaches and telepsychiatry [ 19 ], followed by other areas of mental health including inpatient care; use of clozapine, lithium, and antipsychotics; suicide and self-harm; domestic violence and abuse; substance use disorders [ 20 ]; perinatal care [ 21 ]; and vaccine prioritization [ 22 ] and hesitancy [ 23 ] in the context of mental illness. The team updated the guidance regularly and collaborated with experts in each area to keep the guidance focused, comprehensive, and globally representative.…”