Harm Reduction

  • Many harm reduction supply programs have closed due to COVID-19
  • The VAN provides mobile harm reduction supply services
    • Every night 7:00 pm to 11:00 pm
    • Monday, Tuesday, Wednesday and Friday from 11:00 am to 3:30 pm
    • Thursday from 11:30 am to 3:00 pm.
    • Patients can text/call 905-317-9966 to arrange.
  • Supervised Consumption Space: Hamilton Urban Core Community Health Centre (71 Rebecca Street)

Considerations for Alcohol Use Disorder

  • It would be reasonable to recommend to all of your patients who have an alcohol use disorder that they prepare a two-week supply of alcohol to have on-hand should they be required to self-isolate. This is a great opportunity for education about the risks of abrupt alcohol cessation, including acute alcohol withdrawal, alcohol withdrawal seizures, delirium tremens, and risk of death.
  • Alcohol Withdrawal Management
    • If a patient is self-isolating and will be abruptly ceasing alcohol consumption, discuss their alcohol withdrawal risk (see pg. 16 of META:PHI Handbook) and plan accordingly
    • If low risk for a complicated alcohol withdrawal, consider outpatient withdrawal management with diazepam or lorazepam. See this AAFP article for some guidance on fixed-dosing regimens: https://www.aafp.org/afp/2013/1101/p589.html
    • If a patient is high risk (history of delirium tremens or alcohol withdrawal seizures, age > 65, significant medical co-morbidities, advanced cirrhosis, limited social supports) outpatient withdrawal management would not be recommended and they may require hospital admission
    • If a patient is not self-isolating but is interested in supervised withdrawal management, Men’s Addiction Services of Hamilton (MASH) (Tel: 905 527-9264) or Womankind (Tel: 905-545-9100) are currently remaining open

Considerations for Opioid Use Disorder

  • See the META:PHI / CAMH / OMA guidance document on prescribing of opioid agonist therapy in the context of COVID-19
  • Highlights:
    • Reduce the frequency of in-person visits and use OTN videoconference or phone visits as much as possible
    • Reduce the frequency of urine drug screens required (consider only doing UDS 1x/month unless the results of interim testing will change your clinical management)
    • Clinicians should consider methadone/buprenorphine carry increases or extensions for all patients, except for a minority of patients who would be too unstable to appropriately manage any take-home doses:
      • Intoxicated or sedated when assessed
      • Unstable psychiatric comorbidity (acutely suicidal or psychotic).
      • Recent overdose.
      • Currently using illicit substances in high risk ways; particular caution to be exercised with methadone if patients are using alcohol or benzodiazepines in high-risk ways, or injecting high-dose intravenous illicit opioids
    • For buprenorphine, consider waving witnessed dosing and extending carries up to a maximum of 28 days. Clinician to use discretion about what length of carries is appropriate, but should consider overall stability of patient and their ability to self-manage medications appropriately.
    • For methadone, see the suggested Carry Ladder outlined here
  • IMPORTANT: ensure that the decision-making about take-home dosing, visit frequency, and urine drug screen monitoring is shared with your patient. Many patients with SUD find the above structure and routines a core part of their treatment. Only extend carries and appointment intervals to the extent that your patient feels they will be able to maintain their stability and engagement in care. If they request to continue to give urine drug screens or to have shorter dispensing intervals of their medication because they feel this will assist them in maintaining their progress, this should be considered.

Side note: For patients with CNCP on long-term opioid medication, consider whether urine drug screen monitoring over the next 2-3 months will alter your clinical management. If the answer is that it wouldn’t, consider deferring UDS until the risk of COVID-19 transmission has waned.

OTN Addiction Medicine Consultation

Help is available! Drs. Robin Lennox and Lori Regenstreif are available by OTN econsult. OTN telemedicine visits with patients can also be arranged.

Online Resources

Compiled by Dr. Jennifer Brasch, Addiction Psychiatry

12 Step Online Meetings

AA Sober Living

Online recovery help for those in all stages of recovery, family, friends and loved ones including message boards, chats, blogs, and daily and weekly readings.

aasoberliving.com

SMART Recovery

This website includes message boards, chat rooms, online meetings, and an online library of recovery resources.

smartrecovery.org online

In the Rooms

A free online recovery tool that offers 130 weekly online meetings for those recovering from addiction and related issues. They embrace multiple pathways to recovery, including all 12 Step, Non-12 Step, Wellness and Mental Health modalities.

intherooms.com

The Daily Pledge

This is Hazelden Betty Ford Foundation’s free online Community Social Site. It provides a home page to make a Daily Pledge to sobriety with healthy daily activities to help people see others “recover out loud.”

The site also includes a Discussions forum, Chat, Online Meetings, Fun and Photo sections, private messaging with other members, and other interactive involvements. You need to sign-up to participate.

thedailypledge.org

SoberRecovery

The message board in this directory of recovery resources covers a wide variety of categories: Newcomers, Ask the Experts, General Forums, Alcoholism (AA, Alanon, ACOA), Drug Addiction (NA, Nar-Anon), Family and Friends, Mental Health and much more.

soberrecovery.com

CannabisRehab.org

This free online drug rehab group was originally set up just to help those trying to quit marijuana but they now welcome anyone struggling with drug addiction.

cannabisrehab.org

HAMS Harm Reduction Network

HAMS is a free of charge peer led support group for people who want to reduce the harm in their lives caused by alcohol or other substances. HAMS offers support via a chat room, an email group, and live meetings. HAMS supports every goal from safer use to reduced use to abstinence from alcohol. Their daily chat is schedule for 9 P.M. EST, 6 P.M. PST.

hamsnetwork.org

Compiled by Robin Lennox except where noted above, March 26, 2020

Current Service Availablity

Please see the Addictions section of the Community Services page.

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