Response of tertiary addictions services to opioid dependence during the COVID-19 pandemic

Abstract

The emergence of the COVID-19 pandemic has presented the addiction services with an unprecedented set of challenges. Opioid users are particularly vulnerable because of their high level of pre-existing health problems and lifestyle factors. In order to minimise their risks to self and to others in the current Covid-19 crisis, the service has sought to urgently identify vulnerable individuals, and induct them into OST treatment promptly. Additionally, several guidelines have been created and regularly updated by the HSE for any healthcare staff working with opioid users. These include guidance documents, to facilitate prompt induction of patients onto the OST programme, the prescribing of naloxone to all patients at risk of overdose, eConsultation, medication management for those in self-isolation, and the delivery of injecting equipment. The guidance documents and resources will provide a template for a new way of working for the sector during these challenging times and into the future.

Prevalence and correlates of stocking up on drugs during the COVID-19 pandemic: Data from the C3PNO Consortium

“…( CDC, 2020 , CDC, 2021 , Center for Disease Control, 2022 , Chang et al, 2020 , Chartoff and Carlezon, 2014 , Dubey et al, 2020 , Hennigan et al, 2021 , Reinstadler et al, 2021 )…”

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study

“…In response to these challenges, Ireland, like many other countries, developed a rapid and coordinated response to accelerate new ways of meeting the treatment needs of people with opioid dependency, documented in a suite of national contingency guidelines by the Health Service Executive (HSE) ( Hennigan, Corrigan, Killeen, Scully, & Keenan, 2021 ; Krawczyk, Fawole, et al, 2021 ; Mongan, Galvin, Farragher, Dunne, & Nelson, 2020 ). The priority was to facilitate rapid access or low threshold pathways to OAT for those not already in treatment, while ensuring that existing patients’ care was uninterrupted ( Corace et al, 2022 ; Hennigan et al, 2021 ; Khatri & Perrone, 2020 ; Krawczyk, Fawole, et al, 2021 ; O'Carroll, Duffin, & Collins, 2021 ). The contingency guidelines supported accelerated access to OAT, particularly for the homeless, and included increased access to buprenorphine.…”

“…These temporary amendments also allowed for the emergency supply of five days for controlled drugs, including OAT medications. Finally, the cap on the number of patients a Level 2 GP (specialist GPs qualified to initiate OAT and stabilise OAT drug doses) could initiate on OAT was temporarily increased from 35 to 50 during the pandemic ( Hennigan et al, 2021 ; Mongan et al, 2020 ).…”

Impact of the COVID-19 pandemic on opioid agonist treatment in Ireland: Protocol for an interrupted time series analysis

“…The contingency guidelines also recommended increased prescribing of naloxone, an opioid reversal agent that may mitigate the risks of fatal overdose from opioids, and advice in relation to the management of alcohol and benzodiazepine dependency. Provisions were also made to support people in residential facilities, including isolation hubs and homeless accommodation 11 .…”