COVID-19, Medication-Assisted Treatment, and Increased Risk for Further Respiratory Depression
Authors: Jenny Boyer
Journal: American Journal of Psychiatry (2020)

Back to table of contents Previous article Next article Letters to the EditorFull AccessCOVID-19, Medication-Assisted Treatment, and Increased Risk for Further Respiratory DepressionJenny Boyer, M.D., Ph.D.Jenny BoyerSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jul 2020https://doi.org/10.1176/appi.ajp.2020.20030348AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The COVID-19 infection is characterized by respiratory distress, which has sparked Herculean efforts to increase the supply of ventilators in the United States. Even as the medical establishment races to cope with this pandemic, clinical authorities continue to emphasize the need for opioid agonist treatment, more commonly known as medication-assisted treatment, which includes methadone and buprenorphine. In fact, longstanding rules are now being relaxed to allow people receiving medication-assisted treatment to receive a full 28-day supply of their medication to decrease the spread of the novel coronavirus at treatment centers. Medication-assisted treatment has been demonstrated to significantly decrease mortality associated with substance use. In their recent epidemiological study, Pearce et al. demonstrated that the relative risk of mortality off of medication-assisted treatment was 2.1 (1).In considering the overall health of Americans, including those with known respiratory compromise secondary to long-term tobacco use, asthma, and bronchitis, as well as chronic obstructive pulmonary disease in the elderly and the possibility of respiratory compromise related to vaping among the young, it is important to remember that many of these same patients are also taking prescribed opiates and/or may be misusing opiates. Further, it is essential that those prescribing medication-assisted treatment are acutely aware that these opiate agonists and agonist/antagonists are also capable of causing significant respiratory distress (2). Finally, it is important to remember that benzodiazepines (especially when combined with opiates) are associated with respiratory depression in patients with other respiratory challenges (3).Patients prescribed opiates and benzodiazepines should be advised of these risks and collaborate with their care team to establish the lowest effective dosage of their medications during this pandemic. If nothing else, it is always prudent to periodically review dosages of controlled substances to ensure safety and satisfaction. In cases in which the patient becomes symptomatic and/or has tested positive for COVID-19, clinicians are advised to discuss at least temporarily decreasing the dosage and quantity of prescribed opiates or medication-assisted treatment. In addition, clinicians need to be aware of the availability and value of naltrexone inhalers, which, if prescribed, could prove lifesaving in a patient with respiratory compromise that has been exacerbated by an opiate or opioid agonist treatment.West Texas Health Care System, Big Spring.Send correspondence to Dr. Boyer ([email protected]).The contents of the letter reflect the opinion of the author and do not in any way represent the views or policies of the U.S. Department of Veterans Affairs or the U.S. government.The author reports no financial relationships with commercial interests.References1 Pearce LA, Min JE, Piske M, et al.: Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ 2020; 368:m772Crossref, Medline, Google Scholar2 Substance Abuse and Mental Health Services Administration: Promoting Safety from Opioid Overdose. June 20, 2018. https://blog.samhsa.gov/2018/06/20/promoting-safety-from-opioid-overdoseGoogle Scholar3 American Society of Addiction Medicine: The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. https://www.asam.org/docs/default-source/quality-science/npg-jam-supplement.pdf?sfvrsn=a00a52c2_2Google Scholar FiguresReferencesCited byDetailsCited byCOVID-19, Substance Use, Anorexia Nervosa, 22q11.2 Deletion Syndrome, and StressNed H. Kalin, M.D.1 July 2020 | American Journal of Psychiatry, Vol. 177, No. 7 Volume 177Issue 7 July 01, 2020Pages 636-636 Metrics KeywordsOpioidsOpioid Use DisorderRespiratory CompromiseMedication-Assisted TreatmentPandemicCOVID-19CoronavirusPDF download History Accepted 29 April 2020 Published online 1 July 2020 Published in print 1 July 2020