Reflections and projections on Opiate Use Disorder (OUD) during COVID

By: Deborah Aldridge

COVID has turned our world upside down. Over the last few months, nearly every aspect of daily life has been affected by this novel virus and the implications of spread as each of us adapts to a new normal, those who are experiencing, or at risk for, Opiate Use Disorder (OUD) continue to grapple with initiating and sustaining recovery. In conjunction, several indicators are pointing to a tsunami of mental health and substance use needs coming (1).

Many outlets are sounding the alarm that overdose rates are up, suicide rates are up, and depression, anxiety, and insomnia are starting to show up in increasing volumes, both in burgeoning virtual exam rooms and in online therapy apps (2). We have a brief moment to thoughtfully pause, take a breath and be purposeful in our strategy going forward.

It is past time for healthcare’s antennae to be tuned to increased and targeted screening, and more critically, engagement across various at-risk populations, both for those who have a known mental health and/or substance use condition, and for those who have not previously been identified. According to the National Institute of Mental Health, one in five individuals lives with a mental health condition (3). And according to SAMHSA, one in thirteen (7.8%) have a substance use disorder and one in twenty-seven individuals (3.7%) have both a substance use disorder and a mental illness (4)

For those who have experienced, are experiencing, or who are at risk of experiencing a substance use disorder, isolation and loneliness, increased stress and anxiety, and lifestyle modifications compound the risk of increasing substance use and the potential for addiction or relapse. How many of us have thought to ourselves during this time, “It’s ok, I’ll have another glass of wine and finish the bottle” after watching the evening news or scrolling on social media? The cascade of behavior choices leading to addiction starts with a single step, and some are at higher risk of taking subsequent steps toward developing patterns that result in addiction.

To identify and address these issues, it is critical that providers and patients have new (but frankly not new) conversations as we move forward through these next months and beyond. Increasing patient knowledge of available resources and support options as well as modifications to existing treatment delivery modalities can help stem the fear of the unknown – especially for those who are new to recovery and/or are managing other mental health challenges, such as depression and anxiety. Communication of information remains an important key. SAMHSA has a great list of resources for virtual substance use treatment options to share with patients.

Screening results are another conversation starter to help identify specific patient needs. There are more familiar screenings like PHQ-2/9 (depression) and GAD-7 (anxiety), but providers should also consider incorporating substance use screenings like the CAGE AID or AUDIT (alcohol) and DAST-10 (other drugs). Screening resources can be found here. And frankly, screening, and the initial conversation about the results, is only the first step. Ensuring that identified individuals are linked with timely and appropriate care is and will remain critical. There should be “no wrong door” for individuals to engage with the care team directly and openly regarding all behavioral health treatment needs along with a coordinated infrastructure to support the individual through the process.

Blaze Advisors is supporting these efforts through deployment of its ONEcare model – coordinating various primary, mental health, and substance use providers in concert with adjunct community-based organizations offering SDOH supports, creating a net. This infrastructure ensures each participant service provider shares the same language regarding patient risk and targeted strategies for wrap-around coordination of care and services. It is through purposeful coordination and information-sharing that a safety net operates as a true net, catching those with an assortment of needs and connecting them to the appropriate level of care.

In addition, Blaze Advisors is working with a large urban health system’s emergency department in a pilot program that identifies and engages individuals who are at rising risk for OUD. Using data pulled from the state PDMP, this process seeks to leverage the provider relationship to engage the patient in further exploring their opioid usage patterns and when appropriate, link them to timely treatment and follow-up care – preventing subsequent visits to the emergency department.

We will move through this season, and when we look back to evaluate how we as healthcare providers did and what we could have done better, my hope is that as a whole we supported those with mental health and substance-use needs with empathy, informed strategy, and a well-coordinated infrastructure resulting in successful patient outcomes.

(1) https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/

(2)  https://www.talkspace.com/blog/coronavirus-talkspace-resources/

(3)  https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

(4) https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Assistant-Secretary-nsduh2018_presentation.pdf