Innovation During COVID-19: Improving Addiction Treatment Access

Abstract

During the COVID-19 pandemic, many addiction treatment and harm reduction organizations have had to reduce their hours and services for people with substance use disorders, placing these individuals at increased risk of death. In order to address restricted treatment access during COVID-19, guidance from the Substance Abuse Mental Health Services Administration, the US Drug Enforcement Administration, and the US Department of Health and Human Services has allowed for use of audio-only telehealth encounters for buprenorphine induction without requiring an in-person evaluation or video interface. This has enabled innovations in order to try to meet the needs of the most vulnerable among us during the current pandemic. In this new regulatory environment, we established the Rhode Island Buprenorphine Hotline, a phone hotline which functions as a "tele-bridge" clinic where people with moderate to severe opioid use disorder can be linked with a DATA 2000 waivered provider who can provide an initial assessment and, if appropriate, prescribe buprenorphine for unobserved induction and linkage to outpatient treatment. In this correspondence we briefly share our experience developing this common sense approach to addressing the complex problem of access to treatment only now permissible due to regulatory changes during COVID-19.

New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective

“…Patients under opioid addiction treatment with a reasonable degree of stabilization should obtain several doses of methadone in sufficient quantity for several days or refill their buprenorphine prescription over the phone (26). In the opinion of the authors, the public health community should also focus efforts on the development of virtual support meetings for people with psychiatric disorders or undergoing addiction therapy and the possibility to take home medication (31,32). In addition, it is worth noting that there is a high prevalence of HIV infections, viral hepatitis infections, and liver cancer among intravenous drug users, leading to a weakened immune system.…”

Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic

“…Physical distancing during the COVID-19 pandemic can be life-threatening for individuals who use opioids due to increased overdose deaths from using in isolation, supply chain disruptions, and increased relapse [ 7 , 26 ]. Nandakumar et al [ 27 ] developed a potentially lifesaving contactless mobile phone app to detect opioid overdose by measuring respiratory rate using a short-range active sonar through a mobile phone.…”

“…To address the clinical gap engendered by the pandemic, we recommended that our patients pursue web- or audio-based Alcoholics Anonymous and Narcotics Anonymous groups, which are largely unvetted substitutes, as well as evidence-supported web-based therapies such as cognitive behavioral therapy [ 5 , 6 ]. The Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) have administered policies enabling virtually supported, take-home buprenorphine induction and have created opportunities for patients to access a buprenorphine hotline [ 7 ] and virtual bridge clinic (currently implemented at our institution). Whether these efforts can serve as adequate substitutes for in-person addiction treatment remains to be seen; meanwhile, we need additional, scalable strategies to assist in substance use monitoring and treatment in ways that are practical and acceptable.…”

Digital Clinical Trials for Substance Use Disorders in the Age of Covid-19

“…Although all of this requires additional, creative work on the part of the researchers, it is feasible and has the potential to enhance data collection options for SUD clinical research. 37 As clinical providers struggle with a radical shift towards telehealth and limitations to in-person clinical practice, these procedures developed in clinical trials can help inform treatment guidelines for remote, video-assisted drug testing.…”