COVID 19 and the Treatment of Opioid Use Disorder

 

 

 

 

I’m getting cranky. I know I have plenty of company, figuratively speaking of course. Life’s restrictions chafe at my mood, making me grumble more than usual.

I have nothing to grumble about, I know. Every night I thank God that all the people I love are safe and well and don’t have COVID19. I haven’t lost anyone I love and I’m so fortunate to be living out in the country where we don’t deal with the horrors I’ve seen on the evening news.

And yet, being human, I slip from gratitude to petulance when I see all our COVID snack foods are gone. We just re-upped a week ago. Who is eating all these snacks?

Work had annoying moments last week. Even though we were busier, and I had a few admissions to do each day, I still had down time. We’re out of sanitizing wipes, so I couldn’t make the rounds at our OTP, wiping down surfaces. I had to be content with squirting hand sanitizer on my desk, door handles, and other surfaces. But it’s not the same and leaves some surfaces sticky and unpleasant.

We have no N95 masks, so I wore a Breath Buddy mask this week. (The above picture is of me in my Breath Buddy mask.) The Breath Buddy is a respirator dust mask that I bought to wear when I carve chunks of quartz into bowls and other shapes. I’ve gotten used to wearing the hot and bulky thing, but I’m not used to trying to make myself heard while wearing it, and that was a little taxing and annoying. I think it also annoyed some patients who had to strain to hear me.

I saw several patients last week who relapsed on the extra take home medication they received due to the COVID pandemic. These patients didn’t die and likely won’t have any long-term harm, but one patient was especially demoralized by this setback. I felt very bad for her, because she probably wouldn’t have relapsed without the extra take home doses.

But on a positive note, we don’t have any patients who were diagnosed with COVID 19 with certainty, so far. Several were hospitalized with respiratory failure and tested negative for influenza, so they were told to act as if they had COVID 19, but they weren’t tested for it. It’s hard to know what to make of this. We are giving them extra take homes, and dosing them in their cars, depending on their stability.

I feel we have been generous with extra take home doses of methadone and buprenorphine during the COVID 19 situation. But some patients saw me last week to grumble that they should have received more take homes, or that another patient they know got a few more take-home doses than they did, and that it wasn’t fair. This irritated me but I tried to hear them out, then explained that we did a great number of extra take homes very quickly for an emergency situation and that we may have made some mistakes, but that nearly every patient got extra take homes, except for the extremely unstable. I told these patients I would re-assess their take- home status.

I had a great deal of problems with my attempts to do telehealth with my office-based buprenorphine patients this week. Nearly half of the attempts at connection were so poor that we couldn’t communicate, and I had to call them on the phone instead. It didn’t help that our power went out at our house, so we were running on our generator, which may have affected my internet connection.

All in all, I am doing better than I’m feeling, as I suspect most of us are. I even baked my own COVID snacks. I love to bake scones, but was a little tired of them, so I made the dough as usual but added the only fruit-based thing I could find: a leftover can of cranberry sauce from Thanksgiving. Unfortunately, they came out of the oven looking like something from a crime scene. Fortunately, they tasted great.

We will make due with what we have, until more normal times return.

3 responses to this post.

  1. Please know that you are appreciated. As a patient, I can tell you that it’s easy for us to try and limit our time at the clinic, doing everything we can to just get in, get our medication and possible take homes, cause no problems, rock no boats, and get going. Then when there’s an issue (like jealousy over someone else getting more take homes than we think we deserve, a payment issue, needing an increase but not ever getting it…) it can seem like the only time you hear from us is when we are upset. Just know that your hard work does not go unnoticed by most of your patients, and if they’re like me, they wish they took more time to let you know how grateful they are. Like us, you have bad days, are stressed out, have experienced past trauma, and probably have to work at trusting others. Take a deep breath and know you really are making a difference by the compassion and understanding you show those of us with addiction issues❤️

    Reply

  2. Posted by Chuck the Sham on April 14, 2020 at 8:17 pm

    Thank you, Doc. You aren’t my doctor, but I do have one at my clinic, and he is there for me, just as you are for your patients. You are helping a population that is frequently judged and blamed for their problem. Please keep up the good work!

    Reply

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