Opioids and the COVID-19 Pandemic
Addressing the Opioid Crisis during the COVID-19 Pandemic
During the COVID-19 pandemic, the IHS continues to deliver a comprehensive range of health services, including those to address the opioid crisis. While overdose deaths were already increasing in the months preceding the pandemic, recent data suggest a surge of overdose deaths during the pandemic, primarily from illicit fentanyl and other synthetic opioids. Deaths from drug overdoses increased 30% in 2020 compared to 2019, according to provisional data released by the Centers for Disease Control and Prevention (CDC). Reasons for increased drug overdose rates during the COVID-19 pandemic are multifaceted and may be in part due to reduced access to health care and recovery support services.
Psychological First Aid for COVID-19 Frontline Workers in AI/AN Communities
Basic psychosocial support skills are important for any intervention and key to maintaining and promoting the health of all communities. The Basic Psychosocial Skills Guide was culturally adapted to represent Native peoples, values, and community experiences with COVID-19, resulting in the downloadable publication Psychological First Aid: For COVID-19 Frontline Workers in American Indian/Alaska Native Communities [PDF - 22 MB]
The opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for families and communities. Opioid use affects respiratory and pulmonary health, which may make those with opioid use disorders more susceptible to COVID-19. In addition, chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and decreased lung capacity from COVID-19 could lead to similar health effects. Secondary impacts from the COVID-19 pandemic, including disruptions of treatment and recovery services, limited access to mental health services and peer support, disrupted routines, loss of work, and stress, may lead to increased opioid use and risk of relapse for those in recovery. Risk factors also arise from indirect factors including housing instability and incarceration.
Those with opioid use disorders are at higher risk for housing insecurity, homelessness, and incarceration. Congregate living facilities such as homeless shelters, jails, and prisons are high-risk environments for coronavirus transmission, and there are challenges in implementing recommendations from the Centers for Disease Control and Prevention (CDC) to prevent the transmission and the spread of COVID-19, such as social distancing and quarantine. To address this, the CDC has issued Interim Guidance for Homeless Service Providers to Plan and Respond to COVID-19 and Management of COVID-19 in Correctional and Detention Facilities.
In response to the challenges of the COVID-19 pandemic, our federal partners have provided additional guidance and support on providing care to those with opioid use disorders.
- The Centers for Medicare and Medicaid Services have expanded COVID-19 telehealth services for providers to be reimbursed through Medicare and are expanding coverage for phone-based services; more information on Telehealth During COVID-19 - Reimbursement and Billing.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) is advising that outpatient treatment options, when clinically appropriate, be used to the greatest extent possible due to the substantial risk of coronavirus spread in inpatient or residential facilities. In addition, SAMHSA recommends that outpatient opioid treatment programs be more flexible in providing take-home medication during the COVID-19 pandemic.
- The Drug Enforcement Administration has waived federal requirements for in-person visits before controlled substance prescribing, which includes authorizing prescriptions for buprenorphine for the treatment of opioid use disorders to new and existing patients. In addition, expanding the availability of newer long-acting buprenorphine formulations including a once monthly injection or a six-month subcutaneous implant may be considered for some patients who have stabilized on daily dosing.
Policy and payment strategies including expanded telehealth models support broader access to treatment and recovery services and reduces barriers to care for people with substance use disorders during COVID-19. Comprehensive and coordinated responses to the opioid epidemic that support the peer recovery workforce ,housing, employment, and education opportunities across federal, tribal, and state agencies and local communities can enable continued progress as we face a new public health crisis.
The impacts of the COVID-19 pandemic have been felt throughout the nation, especially in Indian Country. CDC data shows that American Indian and Alaska Native people may be disproportionally affected by the pandemic.
The CDC has created a Drug Overdose Data dashboard that presents provisional counts for U.S. drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. Data may also be customized by each state and predicted or reported value. To use, visit the CDC Drug Overdose dashboard.
Telehealth and Remote Services Resources
Treatment of Opioid Use Disorder (OUD) during the COVID-19 pandemic presents new challenges in care as our patients and healthcare providers navigate rapid systems changes.
The Indian Health Service (IHS) is recognizing the increased need for support and technical assistance by shifting care towards telehealth and remote services.
The IHS Tele-behavioral Health Center of Excellence has created an archive of on-demand webinar recordings that share guidance documents and technical assistance for sites that desire to expand access to telehealth strategies.
During this rapidly evolving situation, providers and their care teams need support, timely information, and resources to care for patients with OUD. The Substance Use Warmline [PDF - 1.2 MB] is an on-demand tele-consultation service that delivers expert recommendations regarding substance use disorder treatment. It is available to all providers practicing in IHS, tribal, and urban facilities.
In response to the challenges of COVID-19, agencies and organizations have provided guidance and resources to assist providers, individuals, and communities. Evidence-based resources including links to clinical roundtables, telehealth tip sheets, recorded webinars, and online trainings are available through:
- American Society of Addiction Medicine COVID-19 Resources
- National Institute on Drug Abuse COVID-19 Resources
- National Institutes of Health (NIH) Resources
- Providers Clinical Support System National and State COVID-19 Resources
- Substance Abuse and Mental Health Services Administration: Coronavirus (COVID-19)
Content provided by LCDR Sherry Daker, PharmD, IHS National Committee on Heroin, Opioids, and Pain Efforts (HOPE Committee).