Berks County Medical Society Medical Record Summer 2020 - 16

Coronavirus Chronicles: Berks Responds

Addiction Medicine
and COVID-19
by William Santoro, MD, FASAM, DABAM
Chief, Section of Addiction Medicine
Reading Hospital - Tower Health

W

e have all been affected by Covid-19; Addiction
Medicine is no exception. But how Covid-19 affected
each of us and our specialty is as unique as each
individual patient. There are four areas I would like to explore as
we look at how our treatment has adapted to care for people in this
time:
Inpatient Drug & Alcohol treatment facilities
Outpatient Office Clinic Programs
Inpatient Hospital Consulting Services
Outpatient Methadone Treatment Programs
When the pandemic started, I was concerned that patients
with a substance use disorder were at higher risk for contracting
Covid-19 and the complications associated with it. Regardless of
the age, patients with a substance use disorder have a higher risk
of homelessness in addition to other barriers for care. It is difficult
to shelter in place when living at a shelter and even more difficult
when living on the streets. And while less people on the streets
could mean less people buying and selling drugs, the reality of it
is that social distancing is the least of their priorities when selling
illicit drugs.

Inpatient Drug & Alcohol Treatment Facilities
One early concern was that there would be a substantial increase
in the number of admissions to the drug and alcohol facilities for
alcohol use disorder. This concern was based in part on the state
liquor stores being closed. Closed bars and liquor stores being
closed could cause a shortage of available alcohol and patients with
an alcohol use disorder could suffer from withdrawals. Patients
immediately began to worry as 12-step meetings were cancelled.
For many patients, meetings are the backbone of their recovery.
Patients with an alcohol or opioid use disorder who rely on
meetings could feel overwhelmed and, with the feeling of having no
control, they could simply give up and use or drink.
Once patients were admitted to an inpatient Drug & Alcohol
treatment facility, changes to the therapeutic community had to be
instituted. Many facilities immediately changed to a model where
each patient had a single room. Group meetings were limited in
size and chairs were placed at appropriate social distances. Patients
were asked to wear masks, wash their hands more often than
they were accustomed to and to keep reasonable personal space
among themselves. While all of these precautions together did

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not guarantee complete safety, as with much in medicine, the risk/
benefit ratio was always considered. It was always felt that the risk
of contracting and spreading the virus was less than the risk of a
person not coming in and, therefore, suffering the consequences of
a substance use disorder not being treated. The benefits of being in
treatment far outweighed the benefits of staying home alone.

Outpatient Office Clinic Programs
Patients who are followed in the outpatient office/clinic setting
who can or need to be seen in an office visit have been seen with
certain precautions and accommodations. First, patients are
screened on the telephone for symptoms of Covid-19. When
they come to the office, their temperature is checked and they are
questioned again. Patients who pass this screening are then checked
in with minimal time spent in the waiting room. Patients are
seated 6 to 10 feet from the physician. Both physician and patient
wear masks. The daily schedule is set to minimize the number of
patients in the waiting room at any given time. Doors that can
be left open are left open. The entire experience in the office was
redesigned with the thought of minimizing the patient's use of their
hands and direct contact with other people. After the visit, all areas
where the patient could have touched are cleaned.
Physicians have been requesting for years to have the ability
of tele-health medicine available to them for patients who are
stable and seen at an outpatient clinic. In the past the barriers to
this were access, security (HIPAA compliant) and reimbursement.
With smart phones so popular today, access should no longer be
an issue. If using an app that comes from a reliable vendor, such
as a local health system, HIPAA compliance can be assured. In
response to this pandemic the federal government relaxed the
security needed when it comes to HIPAA compliance. Although
this is reasonable to do in a crisis, providers need to remember that
this is only a temporary measure and they need to be prepared to
return to the more stringent HIPAA rules as the pandemic passes.
Reimbursement has always, and will always be, a battle to be
fought.
Berks County Medical Society Medical Record Summer 2020

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