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      An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19

      , MD, MS, , MD, , JD, PhD, MPH, , PhD
      Annals of Internal Medicine
      American College of Physicians

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          The COVID-19 pandemic is a particularly grave risk to the millions of Americans with opioid use disorder, who—already vulnerable and marginalized—are heavily dependent on face-to-face health care delivery. These authors propose rapid and coordinated action on the part of clinicians and policymakers to mitigate risks of disrupted care for these patients.

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          Most cited references3

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          Trends in Buprenorphine Treatment in the United States, 2009-2018

          This study assessed the number of individuals receiving treatment for opioid use disorder in the United States by age group and sex using a national prescription database to compare between the number of buprenorphine prescriptions filled and the number of US opioid-related overdose deaths.
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            Telemedicine’s Role in Addressing the Opioid Epidemic

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              Legal requirements and recommendations to prescribe naloxone

              The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior. We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions. As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1 %) or offer a naloxone prescription (2 states, 11.8 %); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8 %) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness. A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.

                Author and article information

                Ann Intern Med
                Ann. Intern. Med
                Annals of Internal Medicine
                American College of Physicians
                2 April 2020
                : M20-1141
                [1 ]Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Medicine, Baltimore, Maryland (G.C.A.)
                [2 ]Johns Hopkins University School of Medicine, Baltimore, Maryland (K.B.S.)
                [3 ]RAND Corporation, Boston, Massachusetts, and University of Michigan, Ann Arbor, Michigan (R.L.H.)
                [4 ]Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (B.S.)
                Copyright @ 2020

                This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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