Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report
Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report
复制标题
DOI：
10.1097/adm.0000000000000682
复制
发表时间：
2020-07-01
影响因子：
5.5
通讯作者：
Taylor, Jessica L.
中科院分区：
文献类型：
--
作者：
Harris, Miriam;Johnson, Samantha;Taylor, Jessica L.
背景资料：为了减少2019冠状病毒病（COVID-19）的传播，许多物质使用障碍治疗计划已经过渡到远程医疗。紧急监管变化允许丁丙诺啡启动无需亲自访问。我们描述了使用视频会议丁丙诺啡启动结合街头推广，从事2例无家可归的患者经历严重的阿片类药物使用障碍（OUD）。病例介绍：患者1是一个30岁的男子，严重的OUD谁曾复发注射海洛因/芬太尼监禁后。一个社区救助中心的外展减少伤害专家在OUD桥诊所与一名成瘾专家举行了一次视频会议。患者完成了社区丁丙诺啡/纳洛酮启动，并自我滴定至其既往剂量，8/2 mg，每日两次。一周后，他再次与外联小组取得联系，进行后续视频会议访问。患者2是一名患有严重OUD的36岁男性，通过注射器服务计划伤害减少专家与成瘾专家联系。他一直试图联系社区丁丙诺啡/纳洛酮提供者，但由于COVID-19，访问受到限制，因此他正在使用转移的丁丙诺啡/纳洛酮来减少阿片类药物的使用。他重新开始了他以前的剂量12/3毫克每天，这是通过电话随访继续16 days.Conclusions：COVID-19相关的监管变化允许丁丙诺啡通过远程医疗启动。我们描述了2个案例，其中远程医疗与街头外展相结合，将无家可归的OUD患者与治疗联系起来。这些病例强调了在要求减少面对面临床互动的大流行背景下为脆弱患者提供挽救生命的OUD治疗的重要机会。
Background: To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD).Case Presentation: Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later.Conclusions: COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.