Patient care for SUD, mental illness, chronic pain during COVID-19

Patients with a substance use disorder (SUD), mental illness or chronic pain are among those who may be acutely affected by interruptions in medical care, including interruptions in access to medications used as part of their treatment regimen. As the COVID-19 pandemic continues to challenge our health care system, the AMA encourages providers to use the information below as guidance to help ensure continuity of care for their patients.

• General guide on prescribing controlled substances during a declared emergency via telemedicine: Applies to chronic pain patients and those stable on buprenorphine treatment for opioid use disorder (OUD), mental illness and chronic pain among other chronic conditions.

The National Institute on Drug Abuse has alerted the research community that populations with Substance Use Disorders (SUDs) may be impacted particularly hard and details implications.

In response to the COVID-19 pandemic, SAMHSA is offering several resources for mental and substance use disorder treatment providers and others. Included among the SAMHSA resources are:

• SAMHSA guidelines about opioids treatment programs (OTPs) prescribing take home treatment medication  (March 16, 2020; updated March 19, 2020)
• SAMHSA FAQs: Provision of methadone and buprenorphine for the treatment of opioid use disorder in the COVID-19 emergency (March 19, 2020)
• SAMHSA OTP guidance for patients quarantined at home with the coronavirus

American Association for the Treatment of Opioid Dependence has prepared a guidance for OTPs which includes useful information related to maintaining medication supply, facility infectious disease control standards, protecting workforces and patients, drug testing and more.

All physicians should be strongly encouraged to co-prescribe naloxone to any patients receiving opioids (and more so for those getting opioids and benzodiazepines).

• Help save lives: Co-prescribe naloxone to patients at risk of overdose (PDF)

• American Society of Addiction Medicine
• American Psychiatric Association
• American Academy of Hospice and Palliative Medicine

With an increased number of people reporting worsening mental health in recent years, it is imperative that people are aware of the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) telephone program.

People experiencing a suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress can call, chat or text 988, and speak to trained crisis counselors. The national hotline is available 24 hours a day, 7 days a week.

The previous National Suicide Prevention Lifeline phone number (1-800-273-8255) will continue to be operational and route calls to 988 indefinitely.