Opioid substitution therapy with buprenorphine-naloxone during COVID-19 outbreak in India: Sharing our experience and interim standard operating procedure

Abstract

Coronavirus disease 2019 (COVID-19) has been declared as a pandemic by the World Health Organization on March 11, 2020. It has affected most countries of the world, including India. Both the disease and the unavoidable national response to it have posed unique challenges to our health-care system. A particular vulnerable group of patients is those with opioid dependence maintained on opioid substitution therapy (OST). These patients are pharmacologically dependent on the OST medication (buprenorphine, buprenorphine-naloxone combination [BNX], and methadone) for their healthy functioning and recovery. COVID-19 outbreak, lock-down, and difficult access to medical care, all are likely to induce stress and withdrawal, which is a potential risk for relapse among individuals with opioid dependence, who are anyway more vulnerable due to social, housing, living, and medical conditions. In this context, it is essential to re-strategize the existing OST services to adapt to the challenging circumstances. In this communication, we share our experience and formulate interim standard operating procedures (SOPs) for running a hospital-based OST service utilizing take-home BNX. The challenges, principles to meet the challenges, and interim SOPs are shared as being currently practiced in our center. Individual institutes, agencies, hospitals, and clinics running OST service with BNX can adapt these SOPs according to their characteristics, needs, demand, and resources; so long as, the basic principles are adhered to.

Mental health research in the lower-middle-income countries of Africa and Asia during the COVID-19 pandemic: A scoping review

“…The Drug E-addiction and Treatment Centre, PGIMER, Chandigarh re-strategized their existing Opioid Substitution Therapy (OST) for patients with opioid dependence, ensuring access to services in these challenging times. The institution formulated interim standard operating procedures (SOPs) to run a hospital-based OST service utilizing take home Buprenorphine- Naloxone ( Basu, Ghosh, Subodh, & Mattoo, 2020 ).…”

Treatment experience for opioid use disorder during COVID-19 in India: Learning from patients

“…Other issues might have resulted in challenges for patients with opioid use disorders in this period, including increased risk of criminal charges due to increased policing, fear of contracting COVID 19 and transmitting it to family members, and stress due to occupational disruption and financial difficulties. Practitioners' cognizance of the current problems affecting those with substance use disorders is important so that effective treatment can be implemented and appraised ( Arya & Gupta, 2020 ; Basu, Ghosh, Subodh, & Mattoo, 2020 ; Clay & Parker, 2020 ; SAMHSA, 2020 ).…”

Opioid agonist treatment during SARS-CoV2 & extended lockdown: Adaptations & challenges in the Indian context

“…Take home dosage of buprenorphine-naloxone is dispensed for a period of 1–2 weeks, depending on the stage of maintenance treatment. We encourage takeaways under the supervision ( Basu et al, 2020 ); d) OAT clinics run by the State governments; presently, only the state of Punjab has a buprenorphine-naloxone based Out-patient Opioid Agonist Treatment (OOAT) program, functioning for the last two years. From all the above-mentioned sources, OAT is available free-of-cost.…”

“…Our publicly funded centre has brought about several changes in the service delivery- a) increase in the number of doses of takeaway buprenorphine-naloxone (2–4 weeks) thus allowing for less frequent follow-ups; b) we have increased the days and hours of operation as well; c) we have initiated proxy dispensing of buprenorphine-naloxone to a responsible family member. An interim guideline proposed by the Indian Psychiatric Society for opioid substitution therapy during COVID-19 outbreak in India ( Indian Psychiatric Society interim guideline, 2020 ; Basu et al, 2020 ).…”