Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future

Clarke, Hance; Weinrib, Aliza; Kotteeswaran, Yuvaraj; Katz, Joel; Yu, Alvis; Tanguay, Robert L.

doi:10.1080/24740527.2020.1795634

Cited by 9 publications

(4 citation statements)

References 35 publications

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“…Delivery services for OAT were developed in some countries (e.g., China; Sun et al, 2020 ) and expanded in others (e.g., Canada), such that more individuals could deliver OAT to patients (e.g., pharmacy technicians, pharmacy employees, and health professionals designated by a patient; Health Canada, 2020 ). Protocols for remote assessments for OUD and initiations of OAT have been documented in Ireland ( Crowley & Delargy, 2020 ) and Canada ( Clarke et al, 2020 ). Emergency centres with harm reduction supplies and OAT were developed for unstably housed individuals in many countries, including Portugal ( European Monitoring Centre for Drugs and Drug Addiction, 2020 ).…”

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confidence: 99%

Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

Corace

Suschinsky

Wyman

et al. 2022

International Journal of Drug Policy

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Background The COVID-19 pandemic has exacerbated the opioid crisis. Opioid-related deaths have increased and access to treatment services, including opioid agonist treatment (OAT), has been disrupted. The Ontario COVID-19 OAT Treatment Guidance document was developed to facilitate access to OAT and continuity of care during the pandemic, while supporting physical distancing measures. In particular, the Guidance expanded access to unsupervised OAT dosing. It is important to evaluate the changes in unsupervised OAT dosing after the release of the Ontario COVID-19 OAT Guidance based on patients’ and prescribers’ reports. Method Online questionnaires were developed collaboratively with people with lived and living expertise, prescribers, clinical experts, and researchers. Patients ( N =402) and prescribers ( N =100) reported their experiences with changes in unsupervised dosing during the first six months of the pandemic. Results Many patients (57%) reported receiving additional unsupervised OAT doses (i.e., take away doses). Patients who received additional unsupervised doses were not significantly more likely to report adverse health outcomes compared to patients who did not receive additional unsupervised doses. Patients with additional unsupervised doses and prescribers agreed that changes in OAT care were positive (e.g., reported an improved patient-prescriber relationship and more openness between patient and prescriber). Prescribers and some patients reported the need for continued flexibility in unsupervised doses after the pandemic restrictions lift. Conclusions Results support the need to re-evaluate historical approaches to OAT care delivery, particularly unsupervised doses. It is crucial to implement policies, regulations, and supports to reduce barriers to OAT care during the pandemic and once the pandemic response restrictions are eased. Flexibility in OAT care delivery, particularly unsupervised dosing, will be key to providing patient-centred care for persons with opioid use disorder.

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mentioning

confidence: 99%

Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

Corace

Suschinsky

Wyman

et al. 2022

International Journal of Drug Policy

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“…On HD 7 (induction day 5) the patient was transitioned to SL buprenorphine dosed every two hours until the total dose within the preceding 24h reached 16mg. This titration scheme was based on our previous experience, as well as others 20 . He was discharged on HD 8 with a prescription for buprenorphine/naloxone SL film 16mg/4mg daily and an appointment with his OTP, which also provided buprenorphine treatment.…”

Section: Methodsmentioning

confidence: 99%

Intravenous Buprenorphine Micro-dosing Induction in a Patient on Methadone Treatment: A Case Report

Crane

Snead

Stanley

et al. 2021

Journal of the Academy of Consultation-Liaison Psychiatry

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Introduction Buprenorphine in the treatment of opioid use disorder (OUD) has several benefits including better long-term treatment adherence (1) and is a safer option for many patients due to buprenorphine’s limited potential to cause respiratory depression (4). In comparison to standard buprenorphine induction, induction via micro-dosing does not require a period of withdrawal and dramatically shortens the time required to complete induction. Prior micro-dosing protocols using sublingual (SL) (7-10) and transdermal forms (11) have been reported. We present a case of buprenorphine induction using a novel inpatient intravenous micro-dosing 4-day protocol in a patient on methadone. Case Presentation A 62-year-old man with chronic obstructive pulmonary disease (COPD) on chronic methadone 80mg daily for OUD presented with respiratory failure and was diagnosed with opioid overdose. He was transitioned from a naloxone infusion to intravenous micro-doses of buprenorphine and low dose methadone without experiencing significant withdrawal, and he was discharged on buprenorphine/naloxone SL. Discussion This case demonstrates a successful and well tolerated buprenorphine induction without interruption of methadone treatment or precipitation of significant opioid withdrawal. To the best of our knowledge, this is the first report describing micro-induction with intravenous buprenorphine.

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“…The success of this pharmacy student-led intervention informs our hypothesis that a medical student-led remote intervention can also increase OEND access. Since the onset of COVID-19, numerous harm reduction programs have adopted novel strategies to reach their patients, including mail- or pharmacy-based naloxone distribution, online, phone, or drive-through trainings, and at-home programs combining OEND provision and buprenorphine induction 8 – 12 …”

Section: Introductionmentioning

confidence: 99%

“…Since the onset of COVID-19, numerous harm reduction programs have adopted novel strategies to reach their patients, including mail-or pharmacy-based naloxone distribution, online, phone, or drive-through trainings, and at-home programs combining OEND provision and buprenorphine induction. [8][9][10][11][12] We describe a medical student-led initiative to provide OEND by telephone to at-risk patients with OUD or a history of opioid overdose during the COVID-19 pandemic. We aim to outline an adaptable model to empower clinics and hospitals with affiliated medical schools to consider novel OEND approaches.…”

Section: Introductionmentioning

confidence: 99%

A Medical Student-Led Model for Telephone-Based Opioid Overdose Education and Naloxone Distribution during the COVID-19 Pandemic

et al. 2022

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Background: The co-occurrence of the COVID-19 pandemic and opioid epidemic has increased the risk of overdose and death for patients with opioid use disorder (OUD). COVID-19 has also exacerbated already limited access to opioid overdose education and naloxone distribution (OEND). In this context, we aim to increase access to OEND for patients at risk for opioid overdose. Methods: Medical student volunteers were trained to conduct telephone-based OEND, and subsequently contacted all patients at a NYC primary care clinic for people who use drugs as well as those presenting to the hospital with OUD or a history of opioid overdose. Interested patients who completed the training received naloxone kits via mail or at hospital discharge. Results: OEND provision was converted to a remote-only model from May to June 2020. During this time, eight pre-clinical medical students called a total of 503 high-risk patients. Of these patients, 165 were reached, with 90 (55%) accepting telephone-based OEND. Comparing across populations, 51% of primary care patients versus 76% of ED/hospitalized patients accepted opioid overdose education. Eighty-four total patients received naloxone. Conclusions: We have outlined a scalable, adaptable model by which clinics and hospitals with affiliated medical schools can provide OEND by telephone. Medical student-driven, telephone-based OEND efforts can effectively reach at-risk patients and increase naloxone access.

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Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future

Abstract: Tanguay (2020) Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future,

Cited by 9 publications

References 35 publications

Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients’ and prescribers’ experiences with changes in unsupervised dosing

Intravenous Buprenorphine Micro-dosing Induction in a Patient on Methadone Treatment: A Case Report

A Medical Student-Led Model for Telephone-Based Opioid Overdose Education and Naloxone Distribution during the COVID-19 Pandemic

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