Oviedo-Joekes Eugenia, MacDonald Scott, Boissonneault Charles, Harper Kelli
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
Subst Abuse Treat Prev Policy. 2021 Mar 5;16(1):22. doi: 10.1186/s13011-021-00358-x.
In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they're financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.
Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics.
In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.
在北美，阿片类药物中毒危机目前正面临着新冠疫情带来的前所未有的挑战，这进一步给已经面临结构和个体脆弱性的个人和社区带来压力。患有阿片类药物使用障碍（OUD）的人在应对新冠疫情时面临着独特的挑战，比如如果他们经济不安全或居住在收容所（或无家可归），就无法采取最佳做法（如保持身体距离）。他们还患有其他疾病，这使他们更易免疫功能低下，有感染新冠病毒的风险。为应对新冠疫情公共卫生紧急情况，国家和省级监管机构出台了指导意见和豁免规定以减轻病毒传播。其中，向开处方者发布了临床指导意见，允许将阿片类药物带回家用于阿片类激动剂治疗（OAT）。仅在针对疫情的严格监管框架内才考虑将注射用阿片类激动剂治疗（iOAT）药物带回家。然而，这种风险缓解指导意见允许将药物（大多为每日配给量）发放给在疫情之前无法获得该药物的人群。在这种情况下，本文提出并讨论了如果在疫情期间可以将药物带回家，那么在新冠疫情之后这种做法也可以继续，以弥补我们在为接受iOAT的OUD患者提供个性化护理方面的差距。
在此，我们介绍加拿大首例长期患有OUD的患者，该患者在急诊室被诊断出患有蜂窝织炎并住院接受抗生素治疗时被确诊感染新冠病毒后，在一个获批地点接受带回家的注射用二乙酰吗啡进行自我隔离。
在本病例中，我们证明了在社区诊所之外提供iOAT是可行的，且没有明显的负面后果。改进并将新冠疫情期间最近出台的这些风险缓解指导意见永久化，不仅有可能在疫情期间起到保护作用，还有可能消除成瘾治疗中获取循证护理方面长期存在的障碍。
