Remote Buprenorphine-Naloxone Initiation As An Essential Service For People With Chronic Pain And Opioid Dependence During The Covid-19 Pandemic: Case Reports, Clinical Pathways, And Implications For The Future

Many health care professions have reacted swiftly to the COVID-19 pandemic. In-person care has been ramped down and telemedicine/telehealth has been thrust to the forefront of clinical care. For people living with chronic pain and often concomitantly dealing with opioid-related issues, this is a time of great stress. With population-wide movements to shelter in place, people living with pain are more isolated, more stressed, and more vulnerable to mental health concerns like depression and anxiety that can increase pain-related suffering. This article presents two case reports of patients struggling with chronic pain and opioid dependence in which a telemedicine-based buprenorphine-naloxone conversion was chosen as a treatment option by two Canadian programs: The Transitional Pain Service at the Toronto General Hospital in Toronto, Ontario, and The Opioid Deprescribing Program in Calgary, Alberta. Both cases presented highlight the use of telemedicine during the COVID-19 pandemic and suggest that there will be substantial need for these services well beyond the apex of the crisis. A buprenorphine-naloxone home induction protocol is presented and we provide insight into important lessons learned regarding the appropriate selection of patients with chronic pain struggling with opioid use disorder for buprenorphine-naloxone conversion. The provision of health care during the COVID-19 pandemic has rapidly forced practitioners to evolve novel health care practices, and these changes will have long-term implications.RESUME De nombreuses professions de sante ont reagi rapidement a la pandemie de COVID-19. Les soins en personne ont diminue, tandis que la telemedecine et la telesante ont ete propulsees au premier plan des soins cliniques. Pour les personnes vivant avec la douleur chronique, souvent confrontees de maniere concomitante a des problemes lies aux opioides, il s'agit d'une periode de grand stress. Avec les mouvements de confinemen de la population mis en place, les personnes vivant avec la douleur sont plus isolees, plus stressees et plus vulnerables aux problemes de sante mentale comme la depression et l'anxiete, qui peuvent augmenter la souffrance liee a la douleur. Cet article presente deux rapports de cas de patients aux prises avec la douleur chronique et la dependance aux opioides oU la conversion a la buprenorphine-naloxone par telemedecine a ete choisie comme option de traitement par deux programmes canadiens : Le Service de la douleur transitoire de l'Hopital general de Toronto, en Ontario, et le Programme de deprescription des opioides a Calgary, Alberta. Les deux cas presentes mettent en evidence l'utilisation de la telemedecine pendant la pandemie de COVID-19 et indiquent qu'il y aura un besoin important pour ces services bien au-dela du sommet de la crise. Un protocole d'induction de la buprenorphine-naloxone a domicile est presente et nous donnons un apercu des seignemens tires quant a la selection appropriee de patients souffrant de douleur chronique et d'un trouble lie a l'usage d'opioides pour la conversion a la buprenorphine-naloxone. La prestation de soins de sante durant la pandemie de COVID-19 a rapidement oblige les praticiens a mettre au point de nouvelles pratiques de soins de sante, et ces changements auront des implications a long terme.