A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report

Abstract

Background: Health services globally are struggling to manage the impact of COVID-19. The existing global disease burden related to opioid use is significant. Particularly challenging groups include older drug users who are more vulnerable to the effects of COVID-19. Increasing access to safe and effective opioid agonist treatment (OAT) and other harm reduction services during this pandemic is critical to reduce risk. In response to COVID-19, healthcare is increasingly being delivered by telephone and video consultation, and this report describes the development of a national model of remote care to eliminate waiting lists and increase access to OAT in Ireland. Purpose and findings: The purpose of this initiative is to provide easy access to OAT by developing a model of remote assessment and ongoing care and eliminate existing national waiting lists. The Irish College of General Practitioners in conjunction with the National Health Service Executive office for Social Inclusion agreed a set of protocols to enable a system of remote consultation but still delivering OAT locally to people who use drugs. This model was targeted at OAT services with existing waiting lists due to a shortage of specialist medical staff. The model involves an initial telephone assessment with COVID-risk triage, a single-patient visit to local services to provide a point of care drug screen and complete necessary documentation and remote video assessment and ongoing management by a GP addiction specialist. A secure national electronic health link system allows for the safe and timely delivery of scripts to a designated local community pharmacy. Conclusion: The development of a remote model of healthcare delivery allows for the reduction in transmission risks associated with COVID-19, increases access to OAT, reduces waiting times and minimises barriers to services. An evaluation of this model is ongoing and will be reported once completed. Fast adaptation of OAT delivery is critical to ensure access to and continuity of service delivery and minimise risk to our staff, patients and community. Innovative models of remote healthcare delivery adapted during the COVID-19 crisis may inform and have important benefits to our health system into the future.

Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID-19 response

“…Many authors highlighted the important role of pharmacies in delivering HR interventions during a pandemictype situation if other services become unavailable [2, [43][44][45]. However, at such times, pharmacies may have reduced opening hours [31]. PWID who participated in the LUCID-B study reported finding the long queues for pharmacies at the start of lockdown very off-putting [23].…”

COVID-19 and the health of people who use drugs: What is and what could be?

“…The adaptive effects of COVID-19 are potentially adverse – linked to risky substance use or reduced access to services – as well as productive for health – linked to how services and interventions and policies innovate in response. Drug treatment services globally have responded with a range of changes to the provision of OAT in an effort to reduce physical interactions since COVID-19 ( Basu et al, 2020 , Crowley and Delargy, 2020 , Dunlop et al, 2020 , EHRA, 2020 , EMCDDA, 2020b , Heimer et al, 2020 ). Historically, the system for OAT provision in many countries is based on supervised daily dosing of methadone and buprenorphine treatment, with the exception of buprenorphine treatment in the United States and France ( Dunlop, et al, 2020 ).…”

COVID-19 and people who use drugs; seizing opportunity in times of chaos

“…As a second illustration of the potential opportunities of the current COVID-19 era, grey literature suggests a significant break-through in the deadlock of low threshold opioid agonist therapy schemes such as multiday prescriptions, in several countries including Morocco, Myanmar, Vietnam, Bangladesh, Iran, Nepal and India. ( UNoDC, WHO, HRI, INPUD, EUROPUD, 2020b ) , ( UNAIDS, n.d., 2000 ) , ( UNAIDS, 2020b ) , ( UNoDC, WHO, HRI, INPUD, EUROPUD, 2020a ) ( INPUD, 2020 )( Crowley & Delargy, 2020 )( WHO, 2009 )…”