ACMT Position Statement: Caring for Patients with Opioid Use Disorder during Coronavirus Disease Pandemic
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POSITION STATEMENT
ACMT Position Statement: Caring for Patients with Opioid Use Disorder during Coronavirus Disease Pandemic Andrew Stolbach 1 & Maryann Mazer-Amirshahi 2 & Evan S. Schwarz 3 & David Juurlink 4 & Timothy J. Wiegand 5 & Lewis S. Nelson 6 Received: 9 July 2020 / Revised: 9 July 2020 / Accepted: 13 July 2020 # American College of Medical Toxicology 2020
The position of the American College of Medical Toxicology (ACMT) is as follows: To provide treatment for patients with opioid use disorder (OUD) while protecting staff and patients from coronavirus disease 2019 (COVID-19), we recommend modifying regulations and practices related to providing treatment for OUD while reducing the need for in-person visits. Government agencies should take steps to facilitate administration of medications for opioid use disorder to patients who may be quarantined. To prevent virus transmission, healthcare systems should expand use of telehealth. When in-person evaluations are required, healthcare systems should maintain physical distance between patients and cohort patients based on infection status. Payers should offer parity in telehealth payments and coverage for telehealth resources including telephone support when direct audio-video is not available to patients. Healthcare providers should take steps to minimize or eliminate the need for in-person visits, and increase use of strategies including remote buprenorphine inductions, administration of long-acting injectable medications, telehealth assessments, and minimization of urine drug screening. Supervising Editor: Mark B. Mycyk, MD * Andrew Stolbach [email protected] 1
Johns Hopkins University School of Medicine, Baltimore, MD, USA
2
Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
3
Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
4
Departments of Medicine and Pediatrics, University of Toronto, Toronto, Canada
5
University of Rochester Medical Center, Rochester, NY, USA
6
Rutgers New Jersey Medical School, Newark, NJ, USA
Background The coronavirus pandemic overlies the ongoing opioid crisis in the USA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, spreads among individuals in close contact with each other. The virus can be transmitted by those who are asymptomatic or minimally symptomatic. Medical and governmental authorities recommend physical distancing measures to minimize person-to-person contact [1]. Historically, treatment for OUD has relied upon inperson visits to perform physical assessment and toxicology testing, and to provide medications and behavioral therapy. Another component of OUD treatment is support groups, which usually occur in person, with multiple individuals present. To decrease the risk of fatal overdose, we have encouraged patients who continue to use opioids not to do so alone. This practice brings people who use drugs in close proximity to
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