July 29, 2020

1. Challenges in Addressing the Evolving
Opioid Crisis During COVID-19
July 29, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.
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3. Challenges in Addressing the Evolving Opioid
Crisis During COVID-19
Getty Images/iStockphoto

4. COVID-19 by population, U.S.A.
4,341,201 cases on 7/28/20 up from 3,858,686 cases on 7/22/20
149,052 deaths https://coronavirus.jhu.edu/map.html

5. Daily New Cases per 100k people
Data shown from 1/22/20 to 7/27/20
https://coronavirus.jhu.edu/data/new-cases-50-states
TWO weeks ago:

6. News updates
• Germany seeing a rise in cases – 3600/1 week
Public Health agency: Germans had become
"negligent" – urged to wear masks and respect
social distancing and hygiene rules
– Vacationers – Spain!
• UK – quarantining returning travelers
– Free, mandatory testing for travelers returning
from high-risk countries, including US and Brazil

7. News updates
• Hong Kong – increasing cases (106 yesterday)
– as life started to go back to normal
– Now: mandatory face masks; closure of dine-in
restaurants; bars/gyms/beauty parlors closed;
gatherings of only 2 people
• California – hoping to avoid ‘second lockdown’
given concerns raised on mental health
– Quarantine fatigue

8. Resources
• Nuvance health:
https://spark.adobe.com/page/LPYqVcgQFwqqh/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

9. Challenges in Addressing the Evolving
Opioid Crisis During COVID-19
Marwan Haddad, MD, MPH, AAHIVS
Dan Bryant, LPC, CCTP
Traci Norman, Program Director
Briana Reaves, MAT Care Coordinator
Presented by the faculty of

10. Initial Attempts
• Reimbursement – Telephone/Video Visits
• Extending prescriptions
• Halting toxicology screens
• Telephone outreach
• Care Coordinators
• No more groups, only individual sessions
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11. Challenges
• Deterioration of care
– Increased relapses and non-fatal overdoses
– Inadequacy of telephone compared to in-person
• Digital divide
• For medical/nursing/especially behavioral health
• Loss of our group support
– Realization of importance for many patients
• Loss of external 12-step recovery groups
– Some may not have telehealth
• Loss higher level of care (IOP)
– Connection to care put on hold
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12. Polling Question
Is your state allowing inductions via
telehealth?
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13. Challenges
• Inductions
– Decreased access
– Regulatory guidelines
• Connecting patients to behavioral health
• Staff Burnout
– Shift to telehealth
– Evolving regulations/procedures
– Social unrest
– Employee wellness/mental health
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14. Patient Challenges
• Attempt to do more in-person visits
– Fear and anxiety from patients to go in person
• Privacy/confidentiality concerns with telehealth
• Some people completely isolated
– Loss of access to soup kitchens, jobs, stress over income,
staying at home
– Delayed social services
• Chat Discussion Question – Please Share!
– What supports did your patients lose due to COVID-19?
– What supports did they gain due to COVID-19?
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15. Response
• Reinstate some toxicology screens
– Drive-up/parking lot saliva testing
– Minimal urine toxicology screens in-person
– Keeping conversations honest
• Minimal nursing visits in-person
– Getting a better “read” on patients
• Attempts to try tele-video groups
– Unsuccessful to date
• Targeted outreach
– Overdose prevention
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16. Case
• 41 year old male with polysubstance use with
(heroin, cocaine, and benzodiazepines)
schizophrenia and mood disorder diagnosis
• Re-engaged in MAT program in April following
a 45 day inpatient program
• Due to consistent use he was referred to a
dual diagnosis IOP
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17. Case Continued
• The dual diagnosis IOP denied the patient and
recommended a dual diagnosis residential
program again
• Due to COVID-19 there was limited availability
for inpatient programs
• Patient and RCC called each week to check the
status of the referral
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18. Case Continued
• After 2+ months the patient was approved for
the inpatient program, however he is
currently still waiting on bed availability
• RCC response to the patient has been
consistently calling to support the patient
through the process
• RCC personal experience
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19. 19 * This initiative is supported by 19

20. Thank You!
www.weitzmaninstitute.org/coronavirus
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Today’s panel is from Weitzman ECHO MAT, a monthly
videoconference education program for prescribers and care
teams.
For more information or to register to observe a session please
visit:
https://www.weitzmaninstitute.org/project-echo/trial