COVID-19 and Mental Health (CMH) Initiative: Research

A Rapid Review of Opioid Substitution Therapy During Major Disruptions to Medical Care

Key Messages

  • Disaster planning must take into account the health care of people who use drugs (PWUDs) and, specifically, individuals suffering from opioid use disorder
  • There is an identified need for:
    • centralized databases with essential information regarding PWUDs, their medical records, and their medications and dosages
    • standardized but flexible guidelines for OST clinic operation during a disaster
    • communication strategies that connect PWUDs with OST clinic staff and with alternative sources of treatment
    • networks of OST clinics that support each other during an emergency
    • transportation strategies based upon links with public and private transport companies

Lay Summary

Disaster planning seldom takes into account the health care of people who use drugs (PWUDs) and, specifically, individuals suffering from opioid use disorder. Disruption of opioid substitution therapy (OST) dispensing and counselling services can have severe consequences for PWUDs such as relapse, withdrawal, and resumption or increase of high-risk injection behaviours. OST programs have to anticipate a wide range of emergency situations and plan accordingly to address them.

Service continuity is essential for reducing physical and psychological distress for OST PWUDs, their families, and their communities. Our findings show that PWUDs are very concerned by the lack of service continuity during a disaster and by the absence of rigorous and systematic OST preparedness planning.

PWUDs and providers worry about communication and transportation issues; lack of standardized manuals, guidelines, and plans to prepare for emergencies; conflicts among laws and regulations governing the operation of OST clinics during a disaster; many regulatory and financial hurdles impeding the daily functioning of OST clinics and the acquisition of opioid medication by PWUDs; and social and cultural conflicts resulting from the relocation of PWUDs and providers to alternative institutions.

Our analysis also identified several potential solutions to many of these challenges, such as: centralized databases with essential information regarding PWUDs, their medical records, and their medications and dosages; standardized but flexible guidelines for OST clinic operation during a disaster; communication strategies that connect PWUDs with OST clinic staff and with alternative sources of treatment; networks of OST clinics that support each other during an emergency; transportation strategies based upon links with public and private transport companies; mental health care for both PWUDs and providers; and the designation of an OST clinic staff member as a Disaster Preparedness Deputy.

Keywords

  • Opioid
  • Opioid use disorder
  • Methadone
  • Buprenorphine
  • Opioid substitution therapy
  • Disruptions to medical care
  • COVID-19
  • Pandemic
  • Disaster preparedness

Author(s)

  • Nominated Principal Applicant: Dr. Ross Upshur, Lunenfeld-Tanenbaum Research Institute (Toronto)
  • Nominated Principal Applicant: Dr. Abhimanyu Sud, Family & Community Medicine, University of Toronto (co-PI)
  • Fabio Salamanca-Buentello, Lunenfeld-Tanenbaum Research Institute (Toronto);
  • Darren K. Cheng, Lunenfeld-Tanenbaum Research Institute – Bridgepoint (Toronto);
  • Ross Upshur, Lunenfeld-Tanenbaum Research Institute (Toronto);
  • Abhimanyu Sud, Family & Community Medicine, University of Toronto

For more information, please contact: Abhimanyu Sud, abhimanyu.sud@utoronto.ca

Related Syntheses

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Population

People Who Use Drugs (PWUD) and Substance Use

Language

To ensure the rapid dissemination of this critical information, information is published in the language in which it was submitted. Please contact us for French or English translations.

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