Coronavirus and Opioid Treatment Programs

covid19

 

 

 

I intended to blog this week about the new mobile opioid treatment program proposed rules, but I’m saving that for later. This week I’m writing about dealing with the Coronavirus at the OTP, and dealing with the fear of the Coronavirus.

Let me preface this blog post by saying I’m not an infectious disease expert, and that I don’t have specific knowledge about the coronavirus outbreak. But I’ve been thinking about ways to protect patients and staff at our opioid treatment program, talking to other Addiction Medicine specialists in our state, and reading advisories for OTPs issued by state and federal agencies.

Those agencies have given us some guidelines and ideas of how to continue to treat our patients as safely and seamlessly as possible, even if some patients and staff contract Coronavirus. That’s the main goal of this blog post: to reassure patients that their OTPs are reading recommendations from SAMHSA (Substance Abuse and Mental Health Services Administration) and SOTAs (State Opioid Treatment Authority). We want to do the best job possible, and we won’t abandon our patients.

Let’s not panic. All of us are scared, unsure what the next days and weeks will bring. But panic often brings more problems than the actual situation. Just look at the unfortunate effect from private citizens who hoarded medical face masks. Now medical personnel are having trouble obtaining face masks that are essential for their jobs. Let’s also take a deep breath and think about how much toilet paper we really need for the foreseeable future, before panic-buying the shelves bare. The plunging stock market is worrisome, but maybe it’s also an opportunity. If I had extra money lying around, I’d invest it now. Again, I have no financial expertise except “buy low, sell high.” And this is as low as the stock market has been for some time.

Our OTP will remain open. We do not plan to close our facility. Personnel who become ill will be asked to stay at home, and we may be short-staffed on some days, but we will be open. Patients do not need to panic about getting their medication. Authorities say they do not expect any shortages of either methadone or buprenorphine products over the coming months, which should be a relief to all patients.

Here are some of the highlights from CSAT (Center for Substance Abuse Treatment), a division of SAMHSA:

-Extra take home doses can be given, after seeking exceptions through the extranet exception website, for patients with confirmed COVID19 infections who are quarantined. This can also be available for people in quarantine because they’ve been exposed to people with COVID infection. These diagnoses and exposures need to be verified by the patient’s healthcare provider, of course.  OTP providers can ask for up to 14 days of take homes, where appropriate.

-Teleconferencing or even just telephones can be used for counseling if face-to-face meetings aren’t feasible, if the technology used meets patient confidentiality standards.

-If a patient is ordered to quarantine at home, authorities are allowing OTPs to deliver medications, or allow a designee to pick up medication and take it to the patient, if chain of custody documentation is done properly. Of course, proof of quarantine will be required.

-CSAT recommends good infection control practices: handwashing, wipe surfaces frequently, ask patients with cough or fever to use masks if available, and use social distancing Though there’s no safe distance to prevent COVID transmission, six feet is recommended. That may be difficult in small counseling offices, but we can get creative.

Though I’m the only physician or medical provider at our OTP, I can work from home if I’m diagnosed with Coronavirus, or exposed to it. These days, secure video conferencing technology is advanced enough that I should be able to carry on with patient care. And thankfully, even though I’m clumsy with technology, I live with my fiancé who is fluent with computers and their programs.

The most medically fragile OTP patients may be able to get more take homes than usual, as decided by the medical director of each OTP. The benefits and risks must be weighed carefully, and the medical director can go through SAMHSA’s exception website to ask permission to give these patients more take homes than usually allowed.

At case staffing a few days ago, we talked about the importance of good hand washing, use of hand sanitizers, and wiping down surfaces frequently that are touched by many people. This would include doors, handles, counters, and the like. To set a good example (and because it was really slow, and I had no patients waiting to see me) I wiped down lobby chairs with sanitizing wipes. I gave them a good scrub and asked our employees to remember to wipe down offices and doorknobs frequently. Am I going to prevent Coronavirus from darkening our doorway? Maybe not, but I felt better as I pictured the Sani-wipes murdering Coronavirus on our patient chairs.

Our OTP has discussed how to change dosing procedures for patients with COVID infections, patients exposed to COVID infections, and for suspected cases of COVID. We want to keep those patients away from the rest of the patients and limit their contact with staff, while still providing needed care. These procedures may cause delays and I hope patients will be patient.

We’ll keep an ear to the news in our area, to stay informed about confirmed cases. I think we will see a spike in the number of COVID19 cases once test kits are available. That will be alarming, but it’s expected, since we haven’t been able to diagnose suspected cases over the last few weeks, due to lack of testing equipment at our local hospital and Health Department.

My biggest message is this: we will not abandon our patients. We will keep working to provide the best care possible under difficult circumstances.

As this pandemic unfolds, we will constantly evaluate the risks and benefits of how we are providing care at our OTP. We’ll look to see what’s working and what’s not working. We may change our minds about procedures as time goes on and we get more information. I think the coming week will give us more data about the extent and locations of COVID infections.

We’ll stay flexible, and we will hope our patients will be patient as we all get through this thing together.

7 responses to this post.

  1. Posted by Does not matter on March 15, 2020 at 10:29 pm

    The clinic in Lowell mass is creating more of a chance you get sick by never having more than 2 of the 5 windows open and that’s just about everyday . I drive someone there and wait outside in amazement that they have a 25-60 minute wait on average , all because the nursing staff is a group of haters , you can tell by the comments they make and their work ethic . You get to work and open at 6am only to take breaks at 615 to make coffee ! When 3 windows are open there is no line , I think having 5 manned for this virus is a must but when your customers can’t complain because who cares what they say it’s a great place to work . Sad

    Reply

  2. Thank you for the information and reassurance. My husband and I are both suboxone patients, and we have been worried about what the Coronavirus could mean for outpatient treatment patients. He actually is already on oxygen therapy and has IPF. Do you think I should call and discuss with our Dr. that prescribes our medicine a plan so he does not have to go to Memphis next week when our appt time is? I am so scared about what will happen if he gets it. I mean really FREAKED out worried about it. We have been together for twenty years and he is everything to me. Our Dr. is in Shelby County (Memphis). We have been reading about people testing positive there. Please let me know what you think. Thanks again for the information!

    Reply

    • Call your doctor and ask her what to do. IF your husband in on oxygen and medically fragile, your doctor might be willing to talk over the phone and send your prescriptions to your pharmacy. I’m assuming you attend an office-based practice from what you said.

      Reply

      • Yes, we do. We do our therapy, drug tests, and see our Dr. once a month every month in his office. Thank you for your reply. I will call them this week because I do not want to take any unnecessary risks for him. Thanks again!

  3. Posted by Brittany on March 16, 2020 at 12:11 pm

    Is this the protocol for every state? I asked my clinic if they had an emergency plan in place in case of a shut down and she said not that she knew of. I live in Kentucky and my clinic only allows 3 take homes.

    Reply

    • Each state is likely different. But I don’t think any clinics are planning to shut down. OTPs provide an essential health service, so they need to be open, unless there are no staff well enough to run them, then patients could dose at the nearest clinic until situation improves.
      SAMHSA has clearly authorized more, IF your medical director feels benefits outweigh risks.

      Reply

  4. Posted by Kim on March 20, 2020 at 7:20 pm

    Our clinic in Somerset Ky has only made changes as far as removing a few chairs. But were still able to access the water jug to mix with our dose also the pad to give out signature is still being used. I told them I could of been exposed to c19 and no changes…I’m also asthmatic and copd what’s your advice

    Reply

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