The Canadian Research Initiative on Substance Misuse (CRISM), a national research consortium focussed on substance use and related harms, is rapidly developing six national guidance documents to address the specific needs of people who use substances, service providers, and decision makers.
https://crism.ca/wp-content/uploads/2020/06/CRISM-Guidance-Medications-and-other-clinical-approaches-22062020-final.pdf
Excerpt from page 11, key points from the guidance document:
• This guidance document is intended to support individuals with a substance use disorder diagnosis who have a presumed (e.g., symptomatic and self-isolating) or confirmed case of COVID-19.
• Extraordinary measures are needed to support people who use drugs, including alcohol, to follow public health directives (e.g., to self-isolate, quarantine, or physical distance) and prevent ongoing community spread of SARS-CoV-2.
• Clinical decision-making should be guided by individual patient circumstances, patientidentified needs and goals, patient and community safety, and the unique risk/benefit ratio for each patient.
• Where possible, prescribers should offer evidence-based treatment according to local or national guidelines. However, not all patients will accept or stabilize on evidence-based treatment options for their substance use disorders. When evidence-based treatment options are not effective, available, or are declined, prescribers may consider alternative strategies—such as prescribing pharmaceutical alternatives or providing other regulated substances—to reduce the risks associated with withdrawal and exposure to SARS-CoV-2.
• For individuals who need to self-isolate and who are at risk of withdrawal from illicit substances (i.e., opioids, benzodiazepines, stimulants), clinical judgment and patient preference should inform prescribing options. These may include initiating and optimizing evidence-based pharmacotherapy, prescribing pharmaceutical alternatives, or a combination of approaches.
• For individuals who need to self-isolate and who are at risk of withdrawal from licit substances (alcohol, tobacco, cannabis), health care providers should work with each individual to determine how best to reduce the risk of withdrawal and support self-isolation. Examples may include initiating or referring to evidence-based treatment, developing a modified managed alcohol plan or plan for at-home withdrawal management, or facilitating access to cannabis.
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• For individuals with co-occurring substance use or substance use disorders, the increased risk of overdose associated with co-ingestion of CNS depressants must also be considered when weighing risks and benefits. For these individuals, clinical judgement should be used, with priority given to providing alternatives for the substances associated with the highest risk of severe withdrawal.
• Health care providers should provide education on harm reduction strategies and access to harm reduction supplies.
• For clients initiating or continuing to be prescribed medication for substance use disorders, prescribers are encouraged to identify pharmacies that offer delivery and have the capacity to transport medication to the client’s place of residence–especially for those in selfisolation due to a confirmed or suspected COVID-19 case.
• This clinical guidance does not replace or nullify existing guidelines.
Stakeholders can also provide feedback on the guidance documents: CRISM Rapid COVID-19 Guidance Documents Feedback Form
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