The COVID-19 pandemic and its impact on addiction treatment

In the brief span of a few weeks, life has changed immeasurably for all of society due to the COVID-19 pandemic. Social distancing and self-isolation have become the norm, workplaces have closed, and virtual care has replaced many face-to-face encounters. Persons suffering from addiction are particularly vulnerable during this time.

While many of us have homes to go to and financial supports to see us through changes that hopefully are relatively short-term, persons suffering with addiction often have less stable housing and more limited financial means. Shelters are typically overcrowded at the best of times and now represent potential sites for rapid viral spread and development of major medical complications due to infection as many are already physically compromised. It is heartening to see colleagues advocating to expand places for the homeless to live and hotels opening their doors to try and help out.

During the pandemic, people have been asked to work at home as much as possible with non-essential workplaces closing voluntarily or by order to decrease the potential spread of the virus. In many jurisdictions, however, provincial alcohol retailers and cannabis stores have been exempted.¹ Fear of precipitating severe withdrawal requiring emergency intervention at a time when hospitals may be overwhelmed with the pandemic is cited as a rationale for the exemption, rather than an ill-advised means to mollify the public. However, alcohol remains one of the leading causes of preventable death, disease, and social dysfunction in our society² and the case for keeping cannabis stores open is lacking as cannabis withdrawal does not require medical intervention and the evidence for benefit of cannabinoids (particularly smoked versions) is very limited.^3,4 Greater advocacy for changes to current policies to minimize their potential unintended harms may be required with novel means to prevent cases of severe alcohol withdrawal, like availability of benzodiazepine tapers available from pharmacists.

Those with addiction seeking help have also found major limitations in access to addiction treatment. Health Canada has fortunately issued a short-term exemption from the Controlled Drugs and Substances Act in the public interest where pharmacists can extend and renew prescriptions, permit transfer of prescriptions from one pharmacist to another, permit verbal prescriptions by practitioners, and allow delivery of prescriptions to enable patients on potentially life-saving opioid agonist therapies to receive them on an ongoing basis.⁵ But, unfortunately, the need for social distancing and the limiting of how many people can come together has shut down most mutual help groups and other addiction group based treatments, requiring them to become virtual groups necessitating access to technology, if they are able to occur at all. In addition, access to detoxification and residential treatment has been significantly reduced despite being challenging to access beforehand. Given the added stress and uncertainty of the current circumstances, increased substance use and addiction relapse for those in recovery is poised to only increase.⁶

Treatment providers can expect to see an increased demand as the pandemic continues and creative solutions will be required. Virtual care is being supported in most jurisdictions, and despite its limitations in being able to fully evaluate and intervene with a level of empathy and connection of an in-person encounter to aid in recovery, it provides a vital connection for an increasingly vulnerable population.⁷ Attempting to provide as many assessments and follow-ups virtually will be vital. Use of technologies, like Zoom, to provide groups should be advocated for, if not already in place. Consideration for using technology for virtual safe consumption, home detoxification, and virtual residential treatment may also be creative solutions, at least in the short term. Not only could this save lives, but also prevent the spread of the pandemic.

The upheaval caused by the COVID-19 pandemic has been great and continues to evolve. The need for advocacy for vulnerable populations, governmental policy changes, and access to care has never been greater for persons suffering with addiction. Our collective unity in getting through this may also help us to refocus on what we value most in the health and welfare of our society. Stay well.