Reevaluating chronic opioid monitoring during and after the COVID-19 pandemic

Abstract

Given the emphasis on social distancing and the possibility of a resurgence of COVID-19, we aim to highlight the evidence and best practices to continue comprehensive and effective opioid management during remote patient interactions to maximize safety for patients and providers, with an emphasis on drug monitoring regimens, while remaining cognizant of the public health challenges at hand. "

Impact of COVID-19 pandemic on chronic pain and opioid use in marginalized populations: A scoping review

“…COVID-19 infection and mortality rates in the general population are higher among the elderly, racial and ethnic minority groups, low SES groups, people with chronic underlying conditions, and people in assisted living facilities or with limited access to care ( 3 , 9 , 81 , 82 , 85 , 89 , 96 , 98–100 ). Thus, many individuals with chronic pain are also at high risk for COVID-19 infection as they may be elderly, those with low SES, smokers, those residing in nursing facilities, those with co-occurring chronic diseases, and those with limited access to care ( 3 , 9 ).…”

“…Increased risk of morbidity can be attributed to the immunosuppressive mechanism of action (i.e., with steroids and opioid analgesics) and the respiratory depressive mechanism of action (i.e., with opioid analgesics) ( 89 ). Within this population, comorbid conditions such as lung disease (e.g., asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, smoking), obesity (i.e., BMI >30), heart disease (i.e., coronary artery disease, cardiomyopathies, heart failure), diabetes (i.e., Type I and Type II), an immunocompromised state (e.g., genetic immunodeficiencies, cancer, HIV, cystic fibrosis), or being of older age further increase risk to complications and comorbidity from COVID-19 infection ( 9 , 82 , 85 , 98 , 99 ). One study found that compared to controls, patients with chronic pain on LTOT infected with COVID-19 were at increased risk of visiting the emergency room (RR 2.04), being hospitalized, (RR 2.91), requiring intensive care, mechanical ventilation, vasopressor support, and dying within 30 days ( 100 ).…”

“…People with chronic pain who use opioids, whether they are on long-acting opioid substitution medication as part of their medication-assisted treatment (MAT) for OUD or on long-term opioid analgesics are at greater risk of morbidity, mortality, healthcare utilization, and severe COVID-19 infection (3,9,81,82,85,89,96,(98)(99)(100). Increased risk of morbidity can be attributed to the immunosuppressive mechanism of action (i.e., with steroids and opioid analgesics) and the respiratory depressive mechanism of action (i.e., with opioid analgesics) (89).…”

“…The combined challenges of using technology, living alone with little to no provision of medication, and an insufficient supply of medication and telehealth appointments contributed to inadequate and disrupted care (81,86). Some healthcare systems lacked infrastructural support for telehealth, especially when telemedicine had not yet been integrated into pain management services before the pandemic (86,98). In addition to reductions in in-person activity, some clinics endured major staffing cuts or lacked appropriately trained staff (i.e., nurse practitioners, general practitioners) in their new telemedicine treatment centers.…”

Detecting Naloxone in Adulterated Urine Samples: Can Naloxone Be Detected When Buprenorphine/Naloxone Film Is Dipped Directly into Urine and Water?

“…The results of this study have implications on clinical practice in the care of OUD patients. With the increased use of unobserved urine toxicology collection in practice [29], the appropriate interpretation of urine drug tests remains a challenging but vital component of comprehensive patient care. Results from this study may suggest that the "naloxone" detected in adulterated urine samples may be dissolved "naloxone" instead of metabolized naloxone, or a fraction of naloxone at least.…”