Cyders, Melissa Anne

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SUD treatment in the context of COVID-19Melissa A. Cyders, PhD, HSPPAssociate Professor of Psychology, IUPUIISAM NIG Psychological response and needs in a disaster• Provide for basic needs• Protect from further harm• Reduce agitation and arousal• Support those most in distress• Keep families together and provide social support• Provide information, foster communication and education• Orient to available services• Use effective risk communication techniques”It’s a marathon, not a sprint.” –US Agency for International Development office, Sri Lanka, January 2005Risk factors for post-disaster psychopathology• Dose of trauma, level of exposure to the event• Prior exposure to trauma such as disaster• Prior psychiatric history• Problems of living prior to disaster/low SES• Lack of perceived or actual social supports after the trauma• Presence of secondary stresses• Female• Middle age• Ethnic minorityCOVID-19 pandemic effects on SUD treatment• Barriers to inpatient treatment • Barriers to regular face-to-face maintenance visits• Increased stress, risk for setbacks• Economic stressors, risk of diversion• Support/recovery groups not meeting (some moving online)• Increased risk of more severe forms of COVID-19• COVID-19 maps onto SUD vulnerabilities• Lockdown policies• Re-purposing of beds, pharmacies, lab, hospitals/clinics to COVID-19COVID-19 guidance for OUD treatment programs and clinicians• Triggers and relapse • Plan for additional stress, make a maintenance plan• Counseling and meetings – look for alternatives to face-to-face meetings• Online options include AA Intergroup (http://aa-intergroup.org/) and Smart Recovery (www.smartrecovery.org, click "online community").• Do not make medication prescription contingent upon meeting/therapy attendance• Drug monitoring• Identify patient-centered strategies, creative solutions to monitoringCOVID-19 guidance for OUD treatment programs and clinicians• Access to medications/interim medications• Continuous access even if quarantined/isolated• Avoid universal monitoring• Telehealth options• Medication delivery option• Consider take home doses as appropriate (despite diversion risks), especially in cases of COVID infection/exposure• Shifting to longer acting medications if possible to reduce visits• Backup system (3-4 providers deep) for your patients if you become unavailable, remote medical access• Smoking and vaping• Travel• Age and Other Medical ConditionsConnections Mobile AppTrends in other parts of the world• “Falling through the cracks in quarantine” • (https://medicine.yale.edu/news/yale-medicine-magazine/falling-through-the-cracks-in-quarantine/)• Medication shortages• Dispensing interruptions• Interruptions in safe injectables• “Non-essential” visits/visitors, triaging of beds, clinic space• Usual sources of drugs not available, what will be substituted• Prolonged effects of this pandemic for SUD treatment communityResources• Fliers shared on ECHO site• https://www.samhsa.gov/coronavirushttps://www.bridgetotreatment.org/covid-19• https://crackdownpod.com/podcast/episode-14-emergency-measures/• https://www.addictionpolicy.org/connections-app• https://www.addictionpolicy.org/post/free-smartphone-app-offering-telehealth-support-for-those-struggling-with-addiction-during-covid-19• https://www.addictionpolicy.org• https://medicine.yale.edu/news/yale-medicine-magazine/falling-through-the-cracks-in-quarantine/

SUD treatment in the context of COVID-19

https://scholarworks.iupui.edu/bitstream/1805/23440/1/SUD-COVID-ECHO.pdf

SUD treatment in the context of COVID-19

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